Morton's neuroma: symptoms, causes, and treatment

Morton's neuroma: symptoms, causes, and treatment

Morton's neuroma is a benign (non-cancerous) growth of nerve tissue that develops in the foot, usually between the third and fourth toes. It is a common and painful condition.

Morton's neuroma has a number of alternative names, including Morton's metatarsalgia, Morton's disease, Morton's neuralgia, Morton metatarsalgia, Morton nerve entrapment, plantar neuroma, and intermetatarsal neuroma.

The condition is due to a swollen nerve in the ball of the foot, normally between the base of the third and fourth toes.

  • Morton's neuroma is not cancerous.
  • Diagnosis is commonly reached on the basis of history, physical exam, and using ultrasound.
  • Surgery is an effective solution but only used if all other treatments fail.
  • The exact causes of Morton's neuroma are still not known.

Symptoms of Morton's neuroma

Foot pain, often described as burning, in the ball the foot is the most common symptom of Morton's neuroma.

Patients experience numbness and pain in the affected area, which is relieved by removing footwear and massaging the foot.

In Morton's neuroma, the tissue around one of the nerves leading to the toes thickens, causing a sharp, burning pain in the ball of the foot.

Outward signs of Morton's neuroma, such as a lump, are extremely rare. Morton's neuroma signs and symptoms usually occur unexpectedly and tend to worsen over time.

The main symptoms is pain on weight bearing (while walking) - a shooting pain affecting the adjacent sides of two toes, which may be felt after only a short time of walking.

Sometimes, there may be a dull pain rather than a sharp one. Most commonly, pain is felt between the third and fourth toes. Typically, a patient will suddenly experience pain while walking and will have to stop and remove their shoe.

Other symptoms include:

  • Burning - this pain, often described as a "red hot needle," can come on suddenly while walking.
  • Numbness - the toes affected may feel numb.
  • Paresthesia - tingling, pricking, or numbness with no apparent long-term physical effect, commonly known as pins-and-needles.
  • A sensation that something is inside the ball of the foot.

Many patients describe the sensation as a burning pain in the ball of the foot that often radiates to the toes.

Initially, the pain might become much more apparent when the person wears tight, narrow, or high-heeled shoes, or engages in activities that place pressure on the foot. Symptoms may be continuous and last for days, and even weeks.

Symptoms can become so severe that affected individuals become anxious about walking or even placing their foot on the ground. In some cases, however, the neuroma is symptomless; MRI scans sometimes reveal Morton's neuroma lesions in patients who have no symptoms at all.

Causes of Morton's neuroma

Wearing high-heeled shoes is a common cause of Morton's neuroma.

Experts are not sure of the precise causes of Morton's neuroma. It seems to develop as a result of irritation, pressure, or injury to one of the nerves that lead to the toes; this triggers a response, resulting in thickened nerve tissue (neuroma).

A high percentage of patients with Morton's neuroma are women who wear high-heeled or narrow shoes. Conditions and situations that can cause the bones to rub against a nerve include:

  • High-heeled shoes - especially those over 5 centimeters, or with a pointed or tight toe box that squashes the toes together. This is probably why the condition is much more common in females than males.
  • High-arched feet.
  • Flat feet - the entire sole comes into complete, or near-complete, contact with the ground.
  • A bunion - a localized painful swelling at the base of the big toe that enlarges the joint.
  • Hammer toe - a deformity within a joint of the second, third, or fourth toe causing it to be permanently bent.
  • Some high-impact sporting activities - including running, soccer, tennis, karate, and basketball. Any sport that places undue pressure on the feet.
  • Injuries - an injury or trauma to the foot may lead to a neuroma.

Treatment options for Morton's neuroma

Surgery is an effective treatment for Morton's neuroma. However, this treatment option is the last resort.

Patients with Morton's neuroma may need to change their footwear, or take painkillers or steroid injections; others might require surgery to either remove the affected nerve, or release the pressure on it.

Treatment for Morton's neuroma depends on several factors, including:

  • the severity of symptoms
  • how long they have been present
  • whether home treatment has been tried - doctors will usually recommend self-help measures first

The earlier the condition is diagnosed, the less likely that surgery will be required.

Self-help measures for Morton's neuroma 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 up).
  • Arch supports (orthotic devices) - a type of padding that supports the arch of the foot, removing pressure from the nerve. There are several OTC metatarsal pads or bars available, which can be placed over the neuroma.
  • Broad-toed shoes - to allow toes to spread out and reduce friction.
  • Taking OTC painkilling medications.
  • Modifying activities - avoiding activities which put repetitive pressure on the neuroma until the condition improves, for instance, taking a break from running.
  • Bodyweight management - a significant number of obese patients with foot problems, such as flat feet, who successfully lose weight, experience considerable improvement of symptoms.
  • Strength exercises - for intrinsic muscles of the foot.

Taking measures to reduce pressure will help reduce the level of pain.

If symptoms are severe or persistent, and self-help measures do not help, the doctor may recommend:

  • Corticosteroid injections - a steroid medication that reduces inflammation and pain is injected into the area of the neuroma. Only a limited number of injections are advised due to potential side effects, including hypertension (high blood pressure) and weight gain.
  • Alcohol sclerosing injections - studies have shown that alcohol injections reduce the size of Morton's neuromas as well as alleviating pain. Injections are typically administered every 7-10 days. For maximum relief, 4-7 injections are usually needed.

Morton's neuroma surgery

If other therapies have not worked and symptoms persist after 9-12 months, it may be necessary to perform surgery.

As surgery can result in permanent numbness in the affected toes, doctors tend to use this procedure as a last resort. However, in most cases, surgery is extremely effective. Surgery involves either removing the nerve or removing the pressure on the nerve by cutting surrounding ligaments or fibrous tissue.

Two surgical approaches are possible:

  • 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.
  • Plantar approach - the surgeon makes an incision on the sole of the foot. In most cases, the patient will be on crutches for about 3 weeks. The resulting scar might make walking uncomfortable. However, with this approach, the neuroma can be reached easily and removed without cutting any structures.

There is a small risk of infection around the toes after surgery.

Diagnosing Morton's neuroma

A doctor or a podiatrist (foot specialist) will ask the patient to describe the pain and its intensity, when symptoms started, what types of shoes are worn, and questions about their job, lifestyle, and hobbies.

The doctor will examine the foot and try to locate the affected nerve. This may involve attempting to reproduce symptoms by manipulating the foot. The doctor might also perform a manoeuvre to elicit a feeling of "clicking" between the toes, this is a sign for Morton's neuroma.

In order to get a detailed image of the inside of the foot, one of the following scans may be ordered:

  • X-rays - these are useful in ruling out other foot injuries, such as a stress fracture.
  • Ultrasound scans - are good for diagnosing Morton's neuroma because they are relatively cheap, require no radiation, and can identify Morton's neuroma with a similar accuracy to an MRI. It can also help distinguish Morton's neuroma from other similar conditions such as synovitis.
  • MRI (magnetic resonance imaging) - this is a more expensive imaging test that can detect Morton's neuroma, even in patients who have no symptoms.

The doctor will have to rule out other conditions that have similar symptoms, including capsulitis, bursitis, or Freiberg's disease.

Morton's Neuroma: Absolute Best Treatment (In Our Opinion) (Video Medical And Professional 2020).

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