Zeehan S. Husain, DPM
Charles G. Kissel, DPM
Michael S. Schey, DPM
Angela
Stoutenburg, DPM
Board
certified by the
American Board of
Podiatric Surgery.
Morton's Neuroma
What
Is a Neuroma?
A
neuroma is a thickening of nerve tissue that may develop in various parts
of the body. The most common
neuroma in the foot is a Morton’s neuroma, which occurs at the base of
the third and fourth toes. It
is sometimes referred to as an intermetatarsal neuroma.
“Intermetatarsal” describes its location in the ball of the
foot between the metatarsal bones (the bones extending from the toes to
the midfoot). Neuromas may
also occur in other locations in the foot.
The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates swelling of the nerve, eventually leading to permanent nerve damage.
Neuromas
in the other intermetatarsal spaces involving toes other than the third
and fourth are extremely rare and should not automatically be assumed they
are neuromas. The podiatric
surgeons at the Rochester Center for Foot and Ankle Surgery are skilled in
differentiating the differences and may avoid you from developing
hammertoes and ligament atrophy with unnecessary treatments and
injections.
Symptoms
of a Morton’s Neuroma
A
true Morton’s neuroma involves the third and fourth toes with pain
between the respective metatarsal heads.
Again, if you have some of these characteristic symptoms but
involving different toes, you may have a neuroma.
If you have a Morton’s neuroma, you will probably have one or
more of these symptoms where the nerve damage in occurring:
 |
Tingling,
burning, or numbness |
|
Pain |
|
A
feeling that something is inside the ball of the foot, or that there
is a rise in the shoe or a sock is bunched up |
The
progression of a Morton’s neuroma often follows this pattern:
|
The
symptoms begin gradually. At
first they occur only occasionally, when wearing narrow-toed shoes or
performing certain aggravating activities. |
|
The
symptoms may go away temporarily by massaging the foot or by avoiding
aggravating shoes or activities. |
|
Over
time the symptoms progressively worsen and may persist for several
days or weeks. |
|
The
symptoms become more intense as the neuroma enlarges and the temporary
changes in the nerve become permanent. |
What
Causes a Neuroma?
Anything
that causes compression or irritation of the nerve can lead to the
development of a neuroma. One
of the most common offenders is wearing shoes that have a tapered toe box,
or high-heeled shoes that cause the toes to be forced into the toe box.
People
with certain foot deformities, bunions, hammertoes, flatfeet, or flexible
feet, are at higher risk for developing a neuroma.
Other potential causes are activities that involve repetitive
irritation to the ball of the foot, such as running or racquet sports.
An injury or other type of trauma to the area may also lead to a
neuroma.
Diagnosis
To
arrive at a diagnosis, the podiatric foot and ankle surgeon will obtain a
thorough history of your symptoms and examine your foot.
During the physical examination, the doctor attempts to reproduce
your symptoms by manipulating your foot.
Other tests may be performed.
The
best time to see your podiatric surgeon is early in the development of
symptoms. Early diagnosis of
a Morton’s neuroma greatly lessens the need for more invasive treatments
and may avoid surgery.
Treatment
In
developing a treatment plan, your podiatric surgeon will first determine
how long you have had the neuroma and evaluate its stage of development.
Treatment approaches vary according to the severity of the problem.
For
mild to moderate cases of neuroma, treatment options include:
|
Padding—
Padding
techniques provide support for the metatarsal arch, thereby lessening
the pressure on the nerve and decreasing the compression when walking. |
|
Icing—
Placing an
icepack on the affected area helps reduce swelling. |
|
Orthotic
devices—
Custom
orthotic devices provided by your podiatric surgeon provide the
support needed to reduce pressure and compression on the nerve. |
|
Activity
modifications—
Activities
that put repetitive pressure on the neuroma should be avoided until
the condition improves. |
|
Changes
in shoewear—
It is
important to wear shoes with a wide toe box and avoid narrow-toed
shoes or shoes with high heels. |
|
Medications—
Non-steroidal
anti-inflammatory drugs (NSAID), such as ibuprofen, help reduce the
pain and inflammation. |
|
Cortisone
injection therapy—
If there is
no significant improvement after initial treatment, injection therapy
may be tried. |
|
Sclerosing
alcohol injection therapy—
Reserved for recurrent neuroma pain unresponsive to previous treatment
that has the effect of chemically destroying the nerve without the
risk of surgery. |
When
Is Surgery Needed?
Surgery
may be considered in patients who have not received adequate relief from
other treatments. Generally, there are two surgical approaches to treating
a neuroma, the affected nerve is either removed or released. Your podiatric surgeon will determine which approach is best
for your condition.
The
length of the recovery period will vary, depending on the procedure or
procedures performed.
Regardless
of whether you have undergone surgical or non-surgical treatment, your
podiatric surgeon will recommend long-term measures to help keep your
symptoms from returning. These
include appropriate footwear and modification of activities that cause
repetitive pressure on the foot.
