A neuroma is an often painful enlargement of one of your body?s nerves. Morton?s neuroma is the name used to describe nerve enlargement in your foot, particularly enlargement of one of the nerves traveling to your toes in your forefoot. Morton?s neuromas most commonly develop in one of your intermetatarsal nerves, one of many nerve branches within your foot that originated in your spine. Morton?s neuroma is more likely to affect women than men.
The exact cause is as yet unclear. However there are a number of theories. Some expert s believe problems with the design of the foot makes some people more prone to Morton?s neuroma. Having flat feet or a high arch for example encourages the foot to slide forwards which can put excess pressure on the metatarsals. Bunions and hammer toes also increase the likelihood of developing Morton?s. However simply wearing high heels or any form of tight shoes that put pressure on the bones in the feet can also lead to a Morton?s . Typically the condition comes on between the age of 40 and 50. It is far more common in women than men – three out of four sufferers are women.
Neuroma pain is classically described as a burning pain in the forefoot. It can also be felt as an aching or shooting pain in the forefoot. Patients with this problem frequently say they feel like they want to take off their shoes and rub their foot. This pain may occur in the middle of a run or at the end of a long run. If your shoes are quite tight or the neuroma is very large, the pain may be present even when walking. Occasionally a sensation of numbness is felt in addition to the pain or even before the pain appears.
To diagnose Morton’s neuroma the podiatrist commonly palpates the area to elicit pain, squeezing the toes from the side. Next he or she may try to feel the neuroma by pressing a thumb into the third interspace. The podiatrist then tries to elicit Mulder’s sign, by palpating the affected interspace with one hand and squeezing the entire foot at the same time with the other hand. In many cases of Morton’s neuroma, this causes an audible click, known as Mulder’s sign. An x-ray should be taken to ensure that there is not a fracture. X-rays also can be used to examine the joints and bone density, ruling out arthritis (particularly rheumatoid arthritis and osteoarthritis).
Non Surgical Treatment
Initial treatment for Morton?s Neuroma may include non-prescription anti-inflammatory medications to reduce pain and swelling. These may consist of standard analgesics such as aspirin and ibuprofen (Advil, Motrin, others). Massaging the painful region three times daily with ice. Change of footwear. Avoid tight shoes, high heels or any footwear that seems to irritate the condition. Low heeled shoes with softer soles are preferable. Arch supports and foot pads to help reduce pressure on the nerve. In some cases, a physician may prescribe a customized shoe insert, molded to fit the contours of the patient?s foot. Reducing activities causing stress to the foot, including jogging, dancing, aerobic activity or any high impact movements of the foot. Injections of a corticosteroid medication to reduce the swelling and inflammation of the nerve and reduce pain. Occasionally other substances may be injected in order to ?ablate? the Neuroma. (The overuse of injected steroids is to be avoided however, as side effects, including weight gain and high blood pressure can result.)
If conservative treatment does not relieve your symptoms, your orthopaedic surgeon may discuss surgical treatment options with you. Surgery can resect a small portion of the nerve or release the tissue around the nerve, and generally involves a short recovery period.