A Morton's neuroma is a benign (noncancerous) swelling along a nerve in the foot that carries sensations from the toes. The reason the nerve starts to swell is unknown. But once swelling begins, the nearby bones and ligaments put pressure on the nerve, causing more irritation and inflammation. This produces burning pain, numbness, tingling and other abnormal sensations in the toes. A Morton's neuroma also is called an interdigital neuroma, intermetatarsal neuroma or a forefoot neuroma.
Wearing shoes that are too tight can make the pain of Morton's neuroma worse. This is because the toe bones are more likely to press on the affected nerve if your shoes are too tight. High-heeled shoes, particularly those over 5cm (2 inches), or shoes with a pointed or tight toe area, can also compress your toes and make the pain worse. This is why women tend to be affected by Morton's neuroma more than men.
Symptoms include: pain on weight bearing, frequently after only a short time. The nature of the pain varies widely among individuals. Some people experience shooting pain affecting the contiguous halves of two toes. Others describe a feeling like having a pebble in their shoe or walking on razor blades. Burning, numbness, and paresthesia may also be experienced. Morton's neuroma lesions have been found using MRI in patients without symptoms.
A GP (general practitioner, primary care physician) or a podiatrist (foot specialist doctor) will ask the patient to describe the pain as well as its intensity, when symptoms started, what types of shoes are worn, as well as some questions about their job, lifestyle and hobbies. The doctor will then examine the foot and try to locate the affected nerve. This may involve attempting to reproduce symptoms by manipulating the foot. In order to get a detailed image of the inside of the food, one of the following scans may be ordered. X-ray, this is a type of high-energy radiation. In low doses they are used to diagnose diseases and condition by making pictures of the inside of the body. In higher doses they are used to treat cancer. This procedure is non-invasive and painless. Ultrasound scan, high frequency sound waves are pointed at a specific part of the body, which in this case is the foot. The ultrasound waves bounce of tissues; their echoes are then converted into a picture, called a sonogram. This allows the doctor to get an inside view of the foot. This procedure is non-invasive and painless. MRI (magnetic resonance imagining) a device that uses a magnetic field and radio waves to create detailed images of the body. Unlike CT scanning or general x-ray studies, no ionizing radiation is involved with an MRI. This procedure is non-invasive and painless. The doctor will have to rule out other conditions which may have similar symptoms, including capsulitis, bursitis, or Freiberg's disease.
Non Surgical Treatment
In most cases, initial treatment for this condition consists of padding and taping to disperse weight away from the neuroma. If the patient has flatfeet, an arch support is incorporated into footwear. The patient is instructed to wear shoes with wide toe boxes and avoid shoes with high heels. An injection of local anesthetic to relieve pain and a corticosteroid to reduce inflammation may be administered. The patient is advised to return in a week or 2 to monitor progress. If the pain has been relieved, the neuroma is probably small and caused by the structure of the patient's foot and the type of shoes the patient wears. It can be relieved by a custom-fitted orthotic that helps maintain the foot in a better position. Another type of therapy that may be used is alcohol sclerosing injections. In this treatment, the doctor injects a small amount of alcohol in the area of the neuroma area to help harden (sclerose) the nerve and relieve the pain. Injections are given every 7-10 days and, in many cases, 4-7 injections are needed for maximum relief. Please ask your physician for more information regarding this type of treatment.
Surgery to excise the neuroma is usually performed under general anaesthetic in a day surgery facility. After surgery you will have to keep your foot dry for two weeks. Generally neuroma surgery allows for early weight bearing and protection in some type of post op shoe gear. Some neuromas may reoccur, but this is rare. Most studies on patient satisfaction after neuroma surgery show approximately 90% reduction of pain and about 85% of all patients rated the overall satisfaction with the results as excellent or good.
To help reduce your chance of developing Morton's neuroma avoid wearing tight and/or high-heeled shoes. Maintain or achieve ideal body weight. If you play sports, wear roomy, properly fitting athletic footwear.