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Morton’s Neuroma

A neuroma is commonly referred to as a pinched nerve. It is a benign growth of nerve tissue and can develop in various parts of the body. Under other conditions, neuromas can be cancerous tumors. But the Morton’s variety is benign and are not considered tumors. Morton’s Neuroma is the most common neuroma found in the foot. It is mainly found between the third and fourth toes. Sometimes it is referred to as an Intermetatarsal neuroma. The term Intermetatarsal explains its location in the ball of the foot between the metatarsal bones. Neuromas may also occur in other sites in the foot.

The main symptom connected with a neuroma is pain between the toes while walking. Primarily women develop neuromas. Frequently, people who suffer from this condition find relief by stop walking, taking off their shoes, and rubbing the affected area on their foot until the pain subsides. At times, the pain is described as similar to having a stone in one’s shoe. This stone feeling is really the thickening of the tissue around one of the nerves leading to the toes, causing a burning, sharp pain in the ball of the foot.

Causes

Even though the exact cause for this ailment is unclear, many issues can aid in the formation of a neuroma. Medical Researchers now think these benign growths are triggered by repeated and intense pressure placed upon the nerves. The thickening of the nerve in the foot becomes compressed due to causes such as improper footwear and repetitive stress applied to the foot. The nerves become inflamed and enlarged, eventually leading to permanent nerve damage. Several underlying factors may increase one’s risk of developing a neuroma:

• People who have particular foot deformities such as bunions, hammertoes, flatfeet, or more flexible feet can set in motion the formation of a neuroma. These foot deformities can produce instability around the toe joints, causing the development of a neuroma.
• Trauma can damage the nerve, producing inflammation or swelling of the nerve.
• Too tight footwear that makes the toes become squeezed together can be a problem.
• Women who wear high heel shoes for professional or fashion reasons risk having a neuroma develop. High-heel shoes often place unnecessary strain on the ball of the foot and surrounding toe bones, which can lead to Morton’s Neuroma.
• Many occupations cause repeated stress on the feet, which can create or worsen a neuroma.
• Sports that cause repetitive irritation to the ball of the foot such as court sports, running, court sports, rock climbing, or snow skiing.

Symptoms

The following are symptoms of a Morton’s Neuroma:

• • Numbness and burning in the ball of your foot.
  • Discomfort in the ball of your foot when weight is placed upon it.
  • Swelling between your toes.
  • Sensitivity and tenderness in the ball of the foot and between the toes.
  • A sensation that something is inside your shoe or the ball of your foot.

These symptoms can be repaired both surgically and non-surgically. The physician will create a specific treatment plan that best suits the severity of each patient’s unique case of a neuroma. After the nerve has become pinched and a neuroma has formed, some type of treatment will be necessary to stop the pain and other uncomfortable symptoms.

The evolution of a Morton’s Neuroma often follows this pattern:

• The symptoms arise gradually. In the beginning, they infrequently appear when wearing narrow-toed shoes or doing certain aggravating activities.
• The symptoms may disappear for the short term by taking off the shoe, massaging the foot, or giving up irritating shoes or activities.
• Over time, the symptoms slowly worsen and may continue for several days.
• The symptoms become more severe as the neuroma enlarges and the temporary modifications in the nerve become permanent.

Diagnosis

One of our Orthopaedic Associates of St. Augustine foot and ankle surgeons will review your symptoms and health to help establish your diagnosis. Your physician may also order x-rays to inspect the affected area to ensure that you have a neuroma and not another condition. During the physical examination, your doctor may attempt to reproduce your symptoms by manipulating your foot.
If possible, it is best to see an expert in the early stages. An early diagnosis of Morton’s Neuroma may reduce the need for more invasive treatments and may help you avoid surgery in the future.

Treatment Options for Morton’s Neuroma

There are both surgical and non-surgical treatments available for neuromas. Surgical procedures are recommended if the neuroma is severe or non-surgical options have been unsuccessful.

Non-Surgical Treatments

In order for your foot and ankle surgeon to develop a treatment plan, he will first need to establish how long you have had a Morton’s Neuroma and what stage of development. If the neuroma is mild to moderate, then standard initial therapies may work, including:

• • Using a cold pack on the affected area will help reduce swelling.
  • Wearing a shoe pad in the affected area to provide better support for the foot. This should reduce the pressure on the nerve.
  • Modify your activities that apply stress to the neuroma.
  • Wearing shoes with a wider toe box will help keep pressure off the neuroma and allow it to heal. From time to time, a simple thing such as changing the type of shoes you wear can produce a significant improvement.
  • Your physician may provide you with custom orthotic devices that will provide foot support, thereby reducing the pressure on your neuroma. Orthotics are soft, cushion-like pads that are put into your shoes. The padding is intended to make your shoes more comfortable and place less stress on your feet.
  • He may suggest medications like ibuprofen to help reduce pain and inflammation.
  • Local anesthetics such as cortisone may be injected to help reduce your symptoms. Steroid injections are used on moderate episodes to decrease swelling and inflammation.
  • Avoid activities that put repetitive pressure on the neuroma until the condition improves.

Patients often experience noticeable relief when a combination of these therapies is utilized.

Surgical Procedures/Treatments

Surgical treatments are only advised after non-surgical treatment therapies have been tried and symptoms have not improved. There are several surgical techniques available for neuromas. All of them require removing the inflamed and enlarged nerve. Your physician will help to decide the best medical procedure for your particular case of a neuroma. Your recovery time will vary depending on the procedure performed.

Two types of surgeries are commonly employed; nerve removal and decompression.

• • Nerve Removal – If the growth has grown to a sizeable length or is causing extensive nerve damage, removing the neuroma and surrounding nerves may be required.
  • Decompression – The surgeon relieves pressure on impacted nerves by removing sections of other nearby structures like soft tissues. More painful cases may benefit from decompression surgery.

Irrespective of whether you have undergone surgical or non-surgical treatment, your foot and ankle surgeon will recommend long-term practices to help keep your symptoms from returning. These include suitable footwear and adjustment to activities to reduce the repetitive pressure on the foot.

Next Steps

If you are concerned that you might have a Morton’s Neuroma, please contact us. Our foot and ankle specialists have wide-ranging experience diagnosing and treating this condition. Talk to your Orthopaedic Associates of St. Augustine physician today to learn more about Morton’s Neuroma.