What Is Mortons Neuroma

Overview

Neuromas are generally benign or non-cancerous growths of nerve tissue, developing in various parts of the body. Morton?s Neuromas are confined to the nerves of the foot, most commonly, between the third and fourth toes. The condition involves a thickening of the tissue around one of the digital nerves leading to the toes and does not qualify as an actual tumor. The affliction causes a sharp, burning pain, usually in the region of the ball of the foot. A patient?s toes may also sting, burn or exhibit numbness. Often, the symptoms have been likened to ?walking on a marble.?

Causes

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.

Symptoms

The most common symptom of Morton's neuroma is localized pain in the interspace between the third and fourth toes. It can be sharp or dull, and is worsened by wearing shoes and by walking. Pain usually is less severe when the foot is not bearing weight.

Diagnosis

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

Treatments may include rehabilitation measures to reduce nerve Irritation. Switching to low-heeled, wide-toed shoes with good arch support. Wearing padding in the shoes and/or between the toes. Wearing shoe inserts to correct a mechanical abnormality of the foot. Having ultrasound, electrical stimulation, whirlpool, and massage done on the foot. The foot may be injected with corticosteroids mixed with a local anesthetic in order to reduce pain. Relief may be only temporary, however, if the mechanical irritation is not also corrected. Injections with other types of medications such as alcohol, phenol, or vitamin B12 are sometimes used.

Surgical Treatment

Surgery for Morton's neuroma is usually a treatment of last resort. It may be recommended if you have severe pain in your foot or if non-surgical treatments haven't worked. Surgery is usually carried out under local anaesthetic, on an outpatient basis, which means you won't need to stay in hospital overnight. The operation can take up to 30 minutes. The surgeon will make a small incision, either on the top of your foot or on the sole. They may try to increase the space around the nerve (nerve decompression) by removing some of the surrounding tissue, or they may remove the nerve completely (nerve resection). If the nerve is removed, the area between your toes may be permanently numb. After the procedure you'll need to wear a special protective shoe until the affected area has healed sufficiently to wear normal footwear. It can take up to four weeks to make a full recovery. Most people (about 75%) who have surgery to treat Morton's neuroma have positive results and their painful symptoms are relieved.