This is a painful condition affecting a small nerve in the foot. It occurs when the five long bones that run the length of the foot get pushed together, pinching the nerve in between. This friction on the nerve causes it to thicken and inflame causing pain. The condition gets its name from an American surgeon, George Morton.
A Morton’s Neuroma is not a true neuroma, which is a tumor that is generally benign. Rather, it is an enlargement of the nerve where it goes between the metatarsal bones of the foot. Because the nerve no longer fits between the gap, the pressure causes pain and sometimes numbness. This enlargement of the nerve is often an inflammation due to irritation. If the forefoot becomes compressed due to shoes that are too narrow, the nerve becomes damaged and inflamed. This inflammation means the nerve no longer fits in the space between the bones, creating further irritation and more inflammation. If this vicious circle can be broken, the problem may be resolved. However, in some situations the nerve can have fibrous tissues formed around it, which may require the destruction of the nerve or surgical removal.
Neuroma patients occasionally complain of a ?pins and needles? sensation that spreads through their feet, or of a feeling akin to hitting their ?funny bone.? The sensation may be described as similar to an electric shock. Some patients also say that these symptoms, as well as those listed above, will come and go, depending on what they are wearing on their feet, the activity they are doing, or on other external factors.
Patients with classic Morton?s neuroma symptoms will have pain with pressure at the base of the involved toes (either between the 2nd and 3rd toes, or between the 3rd and 4th toes). In addition, squeezing the front of the foot together can exacerbate symptoms. As well, they may have numbness on the sides of one toe and the adjacent toe, as this corresponds with the distribution of the involved nerve.
Non Surgical Treatment
There are various options for treating the condition, depending on its severity. Self-treatment. Here are some simple steps that may improve symptoms. Wear supportive shoes with a wide toe box. Do not lace the forefoot of the shoe too tightly. Shoes with shock-absorbent soles and proper insoles are recommended. Do not wear tight or pointed toed shoes or shoes with heels more than 2 inches high. Use over-the-counter shoe pads to relieve pressure. Apply an ice pack to the affected area to reduce pain and swelling. Rest your feet and massage the painful area. There are drugs that may temporarily relieve the pain and other symptoms of Morton?s neuroma. Long-term use of these medications is not recommended. Anti-inflammatory drugs-Nonsteroidal anti-inflammatory drugs, such as ibuprofen or aspirin, may be taken orally to reduce pain and inflammation. Anti-inflammatory drugs can also be administered by direct injection into the skin. Local anesthetic. An anesthetic injection will temporarily relieve pain by numbing the affected nerve. Orthotics. These are custom-designed shoe inserts that can reduce some of the pain associated with Morton?s neuroma. Sometimes padding is placed around the toe area, and tape is applied to hold the padding in place.
If other therapies have not worked it may be necessary to perform surgery. As surgery may result in permanent numbness in the affected toe, doctors ten to use this procedure as a last resort. However, in most cases surgery is extremely effective. The patient usually receives a local anesthetic. Surgery involves either removing the nerve, or removing the pressure on the nerve. Two surgical approaches are possible. The dorsal approach, the surgeon makes an incision on the top of the foot, allowing the patient to walk soon after surgery, because the stitches are not on the weight-bearing side of the foot. The plantar approach, the surgeon makes an incision on the sole of the foot. In most cases the patient will be in crutches for about three weeks. The resulting scar may make walking uncomfortable. However, with this approach the neuroma can be reached easily and resected without cutting any structures. There is a small risk of infection around the toes after surgery.