Mortons neuroma is a noncancerous swelling along a nerve in the foot that carries sensations from the toes. It is sometimes referred to as an intermetatarsal neuroma. Morton's neuroma causes a sharp, burning pain in the ball of your foot. Morton's neuroma occurs in a nerve in your foot, often between your third and fourth toes. The condition is much more common in women than men, probably as a result of wearing high-heeled, narrow-toed shoes. The condition isn't a true tumor, but instead involves a thickening of the tissue around one of the digital nerves leading to your toes. 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. A Morton's neuroma usually develops between the third and fourth toes. Less commonly, it develops between the second and third toes. Other locations are rare. It also is rare for a Morton's neuroma to develop in both feet at the same time. The condition is made worse by athletes who spin on the ball of their foot such as golfers and tennis players.
In some cases, Morton's neuroma may result from abnormal movement of your foot, caused by bunions, hammertoes, flatfeet or excessive flexibility. In some cases, there's no clear cause of pressure or irritation. Pain is usually most significant with more strenuous activity and when wearing shoes with a narrow toebox. Treatment depends on the severity of your symptoms. Your doctor will likely recommend trying conservative approaches first. This may include resting your foot, changing to better-fitting shoes and taking over-the-counter medications to reduce inflammation and relieve pain. High heels cause more weight to be transferred to the front of the foot and tight toe boxes create lateral compression. As a result, there is more force being applied in the area and the nerve compartment is squeezed on all sides. The diagnosis of a Morton's neuroma can usually be made be the doctor when the history of pain suggests it and the examination elicits the symptoms. The reason for continued symptoms after surgery or chemical injections may be that the chronic foot pain or numbness is due to ligament weakness and not a pinched nerve.
Causes of Mortons neuroma
Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. Symptoms of Morton's Neuroma often occur during or after you have been placing significant pressure on the forefoot area, while walking, standing, jumping, or sprinting. The condition seems to occur in response to irritation, pressure or injury to one of the digital nerves that lead to your toes. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or racquet sports. Constricting shoes can pinch the nerve between the toes, causing discomfort and extreme pain. The condition is made worse by athletes who spin on the ball of their foot such as golfers and tennis players.
Common causes and risk factors of Mortons neuroma:
- Injury to your foot.
- High-impact athletic activities, such as jogging, that may subject your feet to repetitive trauma.
- Abnormal movement of your foot.
Signs and Symptoms of Mortons neuroma
The pain is caused by pressure on the enlarged section of nerve where it passes between the metatarsal heads, and is squeezed between them. The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent. Negative signs include no obvious deformities, erythema, signs of inflammation or limitation of movement. Direct pressure between the metatarsal heads will replicate the symptoms, as will compression of the forefoot between the finger and thumb so as to compress the transverse arch of the foot. Symptoms may be aggravated by standing for prolonged periods or by wearing high heels or shoes with a narrow toe box.
Sign and symptoms may include the following :
- Ligament weakness.
- Tingling or numbness in your toes
- A feeling that something is inside the ball of the foot.
- Localized pain can be sharp or dull.
Treatment for Mortons neuroma
Treatment for Mortons neuroma depends on the severity of your symptoms. More rapid relief of symptoms can follow a local cortisone injection. Symptoms can progressively worsen with time. For those with persistent symptoms, the swollen nerve tissue is removed with a surgical operation. Steroids are medications that reduce inflammation. An injection of a corticosteroid medication in the area of the neuroma may reduce pain. However, overuse of injected steroids can lead to a number of side effects, including weight gain and high blood pressure. If conservative treatment does not relieve your symptoms, your orthopaedic surgeon may discuss surgical treatment options with you.
Treatment may include:
- An injection of a corticosteroid medication in the area of the neuroma may reduce pain. However, overuse of injected steroids can lead to a number of side effects, including weight gain and high blood pressure.
- Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
- Placing an icepack on the affected area helps reduce swelling.
- Surgical removal of the growth may be necessary if other treatments fail to provide pain relief.
- If there is no significant improvement after initial treatment, injection therapy may be tried.