Morton’s Neuroma
Anatomy of the Foot
The foot is composed of a complex network of bones, ligaments, tendons, and nerves that work together to provide movement and stability. The interdigital nerves run between the metatarsal bones of the foot and provide sensation to the toes. Morton’s neuroma is a condition that affects one of these nerves, usually between the third and fourth toes, leading to pain and discomfort.
What is Morton’s Neuroma?
Morton’s neuroma is a painful condition that occurs when one of the nerves between the metatarsal bones of the foot becomes irritated, swollen, or thickened. It is not a true tumor but rather a thickening of the tissue around the nerve. Morton’s neuroma most commonly affects the nerve between the third and fourth toes, but it can occur in other areas of the foot as well. The condition is often associated with wearing tight or high-heeled shoes, which can compress the nerves in the forefoot, leading to irritation.
What Happens in Morton’s Neuroma?
In Morton’s neuroma, the nerve becomes compressed and irritated due to repetitive stress or pressure, often caused by wearing poorly fitting shoes or engaging in high-impact activities such as running. Over time, this irritation leads to a thickening of the tissue around the nerve, causing pain, burning, or tingling sensations in the ball of the foot and toes. As the condition progresses, it may become difficult to walk or engage in physical activities without discomfort.
Symptoms of Morton’s Neuroma
- Sharp, burning pain in the ball of the foot, often radiating to the toes.
- A sensation of having a pebble or lump under the foot when walking.
- Numbness or tingling in the affected toes.
- Pain that worsens with activity or when wearing tight or high-heeled shoes.
- Relief from pain when removing shoes or massaging the foot.
How is Morton’s Neuroma Diagnosed?
Diagnosis of Morton’s neuroma typically involves a thorough physical examination and a discussion of the patient’s symptoms. The physician may apply pressure to the affected area to reproduce the symptoms. Diagnostic imaging, such as ultrasound or MRI, may be used to confirm the diagnosis and rule out other potential causes of foot pain, such as stress fractures or arthritis.
How is Morton’s Neuroma Treated?
Treatment for Morton’s neuroma is aimed at reducing pressure on the affected nerve and relieving symptoms. Early intervention with non-surgical treatments can often provide relief, while surgery may be required in more severe cases.
Non-Surgical Treatment
- Footwear Modifications: Wearing shoes with a wide toe box and low heels can reduce pressure on the forefoot and relieve irritation of the nerve. Avoiding tight or high-heeled shoes is crucial in managing symptoms.
- Orthotics: Custom shoe inserts (orthotics) can help redistribute pressure across the foot and reduce irritation of the affected nerve. Metatarsal pads can also help lift and separate the bones, reducing compression on the nerve.
- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help reduce pain and inflammation.
- Corticosteroid Injections: In some cases, corticosteroid injections may be used to reduce inflammation around the nerve and provide temporary relief from pain.
- Physical Therapy: Stretching and strengthening exercises for the foot and lower leg may help relieve pressure on the nerve and improve overall foot function.
Surgical Treatment
If non-surgical treatments fail to relieve symptoms, surgery may be required to remove the thickened tissue or the affected portion of the nerve. The two main surgical options include:
Nerve Decompression: This procedure involves relieving pressure on the nerve by cutting nearby structures that may be compressing it.
Nerve Excision: In more severe cases, the affected portion of the nerve may be surgically removed. This procedure typically results in permanent numbness in the affected toes but provides long-term relief from pain.
Post-Surgical Care
After surgery, patients are usually advised to rest and avoid putting weight on the affected foot for a few weeks. Physical therapy may be recommended to restore strength and flexibility, and patients can typically return to normal activities within a few months, depending on the extent of the surgery.
Prevention of Morton’s Neuroma
Preventing Morton’s neuroma involves wearing properly fitted shoes that provide adequate room for the toes and avoiding high heels or tight shoes that can compress the nerves. Maintaining foot flexibility and strength through regular exercises can also help reduce the risk of developing the condition. Using custom orthotics or metatarsal pads can help distribute pressure across the foot and prevent nerve irritation.
Summary
Morton’s neuroma is a painful condition caused by the compression and irritation of a nerve between the toes, often resulting from wearing tight or high-heeled shoes. Non-surgical treatments such as footwear modifications, orthotics, and corticosteroid injections can provide relief in most cases, while surgery may be required for more severe cases. Early intervention and preventive measures, such as wearing properly fitted shoes and using orthotics, can help prevent the progression of the condition and maintain foot health.
