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Mortons 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 metatarsal bones extend 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.

What causes a neuroma and how is a neuroma diagnosed?

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 such as bunions, hammertoes, flatfeet, or more 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.
 

To arrive at a diagnosis, the podiatric 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 as well to rule out other diagnoses. 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.

If you have a Morton's neuroma, you will probably have one or more of these symptoms where the nerve has increased damage. These symptoms include:
 

• Pain
   
• Tingling, burning, or numbness of the foot.
   
• 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 Morton's neuroma often follow 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.
   

In developing a treatment plan for Morton's neuroma, your podiatric surgeon will first determine how long you've 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, treatments options include:
 

• Placing an icepack on the affected area helps reduce swelling
   
• Nonsteriodal anti-inflammatory drugs (NSAIDS) such as ibuprofen may be prescribed to help reduce the pain and inflammation.
   
• Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
   
• Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
   
• Changing the types of shoes you wear can be beneficial. It is important to wear shoes with a wide toe box and avoid narrow-toes shoes or shoes with high heels. Our video on the perfect shoe selection may help with the changes, click here.
   
• If there is no significant improvement after the initial treatment, corticosteriod injection therapy may be tried.
   
• Custom orthotic devices may be provided by the podiatric surgeon. These devices can be worn inside all your shoes and help provide the support needed to reduce the pressure and compression on the nerve.
   

 When is surgery needed for a Morton's neuroma?
 

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've undergone surgical or nonsurgical 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.

Copyright © 2006, American College of Foot and Ankle Surgeons.