Also known as Morton’s Interdigital Neuroma, Morton’s Metatarsalgia, Morton’s Neuralgia, Plantar Neuroma, Intermetatarsal Neuroma) What is a Morton’s neuroma? Morton’s neuroma is a condition characterized by localized swelling of the nerve and soft tissue located between two of the long bones of the foot (metatarsals – figure 1), which can result in pain, pins and needles, or numbness in the forefoot or toes.
When a nerve is pinched between bones, the result is swelling of the nerve. It is this swelling which is referred to as a Neuroma. When the condition occurs in the foot, it is known as a Morton?s Neuroma. Morton?s Neuroma is technically not a tumor. Rather, it is a thickening of the tissue that surrounds the digital nerves leading to the toes. These nerves allow for physical sensation on the skin of the toes. The region of inflammation is found where the digital nerve passes under the ligament connecting the toe bones (metatarsals) in the forefoot. Morton?s Neuroma commonly develops between the third and fourth toes, generally as a result of ongoing irritation, trauma or excessive pressure. In some cases, the second and third toes are involved. Morton?s Neuroma is confined to one foot in most cases, though it can occur in both, particularly in athletes such as runners.
Symptoms associated with a neuroma include a dull burning sensation radiating towards the toes, a cramping feeling, or even a stinging, tingling sensation that can be described as being similar to an electric shock. It is often worse when wearing shoes with most people finding the pain disappears when removing their shoes.
Your podiatric physician will begin by taking a history of your problem. Assist him or her by describing your condition as well as you can. Keep track of when the symptoms started and how, any changes you?ve noted (whether the pain has gotten worse, or whether other symptoms have appeared as well, etc.). If you?ve noticed that certain activities or footwear make things worse or bring about additional symptoms, be sure to mention that. If you work in specific footwear, or if you participate in any certain sports, bring the shoes you use. Your doctor may be able to learn quite a lot about your condition that way!
Non Surgical Treatment
Initial therapies are nonsurgical and can involve one or more of the following treatments Changes in footwear. Avoid high heels or tight shoes, and wear wider shoes with lower heels and a soft sole. This enables the bones to spread out and may reduce pressure on the nerve, giving it time to heal. Custom shoe inserts and pads also help relieve irritation by lifting and separating the bones, reducing the pressure on the nerve. One or more injections of a corticosteroid medication can reduce the swelling and inflammation of the nerve, bringing some relief. Massaging the affected area can provide some momentary relief. Several studies have shown that a combination of roomier, more comfortable shoes, nonsteroidal anti-inflammatory medication, custom foot orthoses and cortisone injections provide relief in over 80 percent of people with Morton?s Neuroma. If conservative treatment does not relieve your symptoms, your physician may discuss surgical treatment options with you.
Surgery to excise the neuroma is usually performed under general anaesthetic in a day surgery facility. After surgery you will have to keep your foot dry for two weeks. Generally neuroma surgery allows for early weight bearing and protection in some type of post op shoe gear. Some neuromas may reoccur, but this is rare. Most studies on patient satisfaction after neuroma surgery show approximately 90% reduction of pain and about 85% of all patients rated the overall satisfaction with the results as excellent or good.