Mortons Neuroma Overview

Overview

Morton neuromaA morton's neuroma (or an "inter-digital" neuroma) is found between the toes of the foot, most commonly the third and fourth toes. It can also occur between the metatarsal bones (the long bones in the forefoot). It is basically an entrapped nerve, which becomes inflamed due to constant irritation from the surrounding bony structures.

Causes

Unfortunately, the cause of Morton?s Neuroma remains unknown to researchers. It is likely that a variety of factors may play a role in the development of this condition, including the presence of chronic pain conditions like fibromyalgia. Factors that may contribute to the development of Morton?s Neuroma include Wearing improperly fitting shoes can cause pressure on your foot, leading to swelling around the toe nerves. High heels are of particular concern as they cause a large amount of weight to be shifted to the ball of the foot. Repetitive activities like jogging, walking, and aerobics can also place a lot of pressure on the feet. This could lead to Morton?s Neuroma. Having a previous foot or muscle injury may cause you to hold your foot in a poor position when walking, contributing to nerve inflammation. Some people are just born with poorly shaped feet. People with extremely low arches or "flat feet" may suffer from Morton?s Neuroma more than others.

Symptoms

Normally, there are no outward signs, such as a lump, because this is not really a tumor. Burning pain in the ball of the foot that may radiate into the toes. The pain generally intensifies with activity or wearing shoes. Night pain is rare. There may also be numbness in the toes, or an unpleasant feeling in the toes. Runners may feel pain as they push off from the starting block. High-heeled shoes, which put the foot in a similar position to the push-off, can also aggravate the condition. Tight, narrow shoes also aggravate this condition by compressing the toe bones and pinching the nerve.

Diagnosis

During the examination, your physician will feel for a palpable mass or a "click" between the bones. He or she will put pressure on the spaces between the toe bones to try to replicate the pain and look for calluses or evidence of stress fractures in the bones that might be the cause of the pain. Range of motion tests will rule out arthritis or joint inflammations. X-rays may be required to rule out a stress fracture or arthritis of the joints that join the toes to the foot.

Non Surgical Treatment

Treatment for Morton?s neuroma will depend on how long you've had the condition and its severity. Simple non-surgical treatments are effective for some people. Others may need surgery. If Morton's neuroma is diagnosed early, treatment will aim to reduce the pressure on the affected nerve. This is usually the nerve between the third and fourth toe bones (metatarsals). Your GP or podiatrist (foot specialist) may recommend changing the type of shoes you usually wear, shoes with a wider toe area may help ease the pressure on the nerve in your foot. Using orthotic devices, such as a support for the arch of your foot to help relieve the pressure on the nerve. Anti-inflammatory painkillers or a course of steroid injections into the affected area of your foot may help ease the pain and inflammation. Alcohol and local anaesthetic is injected into your foot using ultrasound for guidance, studies have shown that this type of treatment is effective. Resting your foot and massaging your toes may also help to relieve the pain. You can make an ice pack by freezing a small bottle of water and rolling it over the affected area.Morton

Surgical Treatment

Operative treatment of Morton?s neuroma should be entertained only after failure of non-operative management. Standard operative treatment involves identifying the nerve and cutting (resecting) it proximal to the point where it is irritated/injured. This is usually done through an incision on the top (dorsal) aspect of the foot, although an incision on the sole (plantar) aspect of the foot can be used. Some physicians will attempt to treat Morton?s neuroma by releasing the intermetatarsal ligament, and freeing the nerve of local scar tissue. This may also be beneficial.
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