During certain activities, particularly weight-bearing activities (e.g. walking or running) a compressive force, is sometimes placed on the interdigital nerves and surrounding soft tissue, between the metatarsal bones (this is often the case with tight fitting shoes or in patients with flat feet). If this force is repetitive enough and beyond what the nerve and soft tissue can withstand, swelling to the nerve and soft tissue may occur. This may result in pain, tenderness, pins and needles or numbness in the forefoot or toes. When this happens, the condition is known as a Morton’s neuroma.
Although in many areas of medicine, it?s easy to pinpoint the exact source of a problem (the way a specific germ causes a certain illness with recognizable symptoms), neuromas are harder to categorize. While there isn?t really one exact cause, podiatric physicians tend to agree that a neuroma can occur in response to the irritation of a nerve by one or more factors. Abnormality in foot function or foot mechanics: In other words, a foot that doesn?t move the way science thinks it should. In general, this means a pronated foot (one with an excessive rolling motion when the patient is walking, running or doing any kind of activity), because it causes excessive strain on the nerve. If you are not certain whether or not this is a problem for you, ask your podiatric physician, who will be able to examine your feet, as well as the wear pattern on your shoe, and give you an answer. Foot mechanics, and problems with them, tend to run in families, so if you know that a relative has had foot pain similar to yours, be sure to mention it.
Morton’s neuroma can cause a very painful burning or sharp pain in your foot that feels worse when you walk. It may feel like a small lump inside the ball of your foot. It is usually between the third and fourth toes, but it can also be between other toes.
Your doctor will suspect that you have a Morton’s neuroma based on the nature and location of your foot pain. He or she may ask questions about your shoes – what type of shoes you usually wear and whether these shoes have narrow toes or high heels. To rule out other causes of foot pain, your doctor may ask questions about your medical history, especially any history of arthritis, nerve and muscle problems or previous injury to your foot or leg.
Non Surgical Treatment
Treatment for Morton’s neuroma may depend on several factors, including the severity of symptoms and how long they have been present. The earlier on the condition is diagnosed, the less likely surgery is required. Doctors will usually recommend self-help measures first. These may include resting the foot, massaging the foot and affected toes. Using an ice pack on the affected area (skin should not be directly exposed to ice, the ice should be in a container or wrapped in something) Changing footwear, wearing wide-toed shoes, or flat (non high-heeled) shoes. Trying arch supports (orthotic devices). A type of padding that supports the arch of the foot, removing pressure from the nerve. The doctor may recommend a custom-made, individually designed shoe-insert, molded to fit the contours of the patient’s foot. There are several OTC (over the counter, non-prescription) metatarsal pads or bars available which can be placed over the neuroma. Taking over-the-counter, non-prescription painkilling medications. Modifying activities, avoiding activities which put repetitive pressure on the neuroma until the condition improves. Bodyweight management,if the patient is obese the doctor may advise him/her to lose weight. A significant number of obese patients with foot problems, such as flat feet, who successfully lose weight experience considerable improvement of symptoms.
When medications or other treatments do not work, podiatric surgery may be required. The most common surgical procedure for treating Morton?s neuroma is a neurectomy, in which part of the nerve tissue is removed. Although this procedure effectively removes the original neuroma, sometimes scar tissue known as a stump neuroma forms at the site of the incision. This may result in tingling, numbness, or pain following surgery. Surgery is effective in relieving or reducing symptoms for Morton?s neuroma patients in about 75% to 85% of all cases. Occasionally, minimally invasive radio frequency ablation is also used to treat Morton’s neuroma.