Morton’s neuroma is a painful compression of a nerve in the foot.
Morton’s neuroma is a benign (noncancerous) “nerve tumor” or growth of nerve tissue in the foot, most often occurring between the third and fourth toes. Though it may be referred to as a nerve tumor, Morton’s neuroma is not actually a tumor, but tissue that thickens around the digital nerve leading to the toes. This nerve affects the ball of the foot. Morton’s neuroma is a persistent painful condition that may require medical intervention.
Morton’s neuroma should not be confused with Morton’s toe, which is a condition where the second toe is longer than the first. This condition may also cause foot pain and discomfort, but has different symptoms, including arch pain, middle (second) toe pain and problems with shoe fit.
What Are the Symptoms of Morton’s Neuroma?
Because Morton’s neuroma is not a tumor, the outside of the foot may appear normal with no visible lump. However, there are painful symptoms associated with Morton’s neuroma, such as:
- Feeling of standing on a pebble or marble
- Burning pain in the ball of the foot
- Radiating pain from the ball of the foot to the toes
- Numbness in the toes
- Tingling in the toes
- Indistinct, but uncomfortable feeling in the toes
Physical activity or wearing shoes may aggravate the neuroma.
What Are Causes and Risk Factors of Morton’s Neuroma?
Morton’s neuroma usually develops in response to excessive pressure on the foot, trauma or persistent irritation. Causes and risk factors include:
- Being female – women experience Morton’s neuroma 8 to 10 times more often than men
- High-heeled shoes
- Tight, narrow shoes, which cause compression of the toe bones and pinch the digital nerve
- Other sports requiring tight shoes and repetitive trauma – skiing, rock climbing, jogging
- Foot deformities – high arches, flat feet, bunions and hammertoes may increase risk
How Is Morton’s Neuroma Diagnosed?
A physical exam is usually the first step to diagnosing Morton’s neuroma. The doctor will palpate (feel) the foot for a tender spot or mass, listen or feel for a clicking between the bones, inspect the foot for calluses and look for evidence of stress fractures in the bones. The doctor may put pressure on the affected space between the third and fourth toes to induce pain.
Additional tests include range of motion to rule out inflammatory joint conditions or arthritis and X-rays to rule out stress fractures or arthritis of the toe joints. If further testing is required, ultrasound or magnetic resonance imaging (MRI) tests may be ordered.
What Are the Treatment Options for Morton’s Neuroma?
Treatment for Morton’s neuroma varies based on the severity of the pain. Conservative, nonsurgical therapy is almost always tried first and includes:
- Arch supports and foot pads for inside shoes – may be over-the-counter or custom-made to fit exact contours of the foot (orthotics)
- Avoiding high heeled shoes – switch to wide shoes with low heals and soft soles
- “Morton’s shoes” – shoes specifically for people with Morton’s neuroma are available in styles from dressy to sporty
- Corticosteroid injections to reduce swelling and inflammation of the nerve
Research has shown that a combination of these methods provide relief for more than 80 percent of Morton’s neuroma patients.
Another nonsurgical option is neuroablation. Neuroablation means destroying the nerve function to prevent the transmission of pain signals. This is generally done in one of three ways, all minimally invasive:
- Alcohol injections
- Cryoablation—destroying the nerve with cold
- Radiofrequency ablations—destroying the nerve with heat
For those patients who do not respond to conservative treatment, surgery may be recommended. Surgical options include removing the affected part of the nerve or releasing (cutting) the tissue or ligament around the impinged nerve. Recovery is usually very quick; however, permanent numbness in the affected toes is a surgical risk.
There are some home treatments that can also help reduce the pain of Morton’s neuroma, including:
- Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen or naproxen
- Ice massage – freeze water in a disposable cup and roll over the painful area
- Reduce high impact activities for a few weeks
Foot pain lasting longer than a few days should not be ignored. If you have foot pain or suspect that you may have a Morton’s neuroma, contact Essex Union Podiatry today to schedule an appointment.
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