Posts for tag: Morton's Neuroma
- Trauma or injury to the foot, damaging the nerve and resulting in swelling.
- Improper footwear, like shoes that squeeze the foot together. High heels also increase pressure on the vulnerable areas.
- Recurring stress to the feet through repeated physical activities or exercise. This is common with patients who are constantly on their feet due to their job.
- Deformities of the foot, like a high arch or flat foot. These lead to instability throughout the foot.
- Taping and padding: This is a special type of tape and bandages that you place on the bottom of the foot. This helps with your symptoms.
- Orthotics: These are the custom shoes that your podiatrist can create for you.
- Medication: Cortisone injections reduce the pain and inflammation in the foot. Anti-inflammatory drugs also reduce your swelling.
- Surgery is the last resort for treatment. The procedure is done on an outpatient basis. The injured nerve is removed and recovery takes a few weeks.
A neuroma is a thickening of nerve tissue that can develop in various parts of your body. In the foot, the most common occurring neuroma develops at the base of the third and fourth toes. This condition is referred to as Morton's neuroma.
There are typically no physical signs of Morton's neuroma, such as a lump or a knot. Instead, symptoms may include:
- A sharp, achy or burning pain in the ball of your foot
- Numbness, tingling, or cramping in the toes or forefoot
- Feeling as if you're standing on a pebble in your shoe
While the exact cause of Morton's neuroma is unknown, the growth of the neuroma seems to occur in response to injury, pressure or irritation to one of the nerves that lead to the toes. People with foot deformities such as bunions, hammertoes and flat feet are at higher risk for developing a neuroma. Women are also more likely to develop this condition, as wearing high-heels or narrow-toed shoes can increase pressure on the toes. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running.
Morton's neuroma can make walking and performing normal activities difficult and painful. Treatment options vary with severity, and identifying the neuroma in its earliest stage of development is important to avoid more invasive treatments or surgical correction. Left untreated, neuromas tend to worsen, so it's always best to visit our office at the first sign of pain.
Early treatments aim to relieve or reduce pressure on the area around the affected toes. Depending on the severity of your neuroma, a podiatrist may recommend:
- Modifications to footwear. Wide-toed shoes relieve pressure on the neuroma.
- Shoe inserts or padding to provide support for the arch of the foot, which removes pressure from the nerve.
- Anti-inflammatory medications can help ease any pain and inflammation. Ask your doctor first.
- Icing to reduce inflammation.
- Rest to lessen repetitive pressure on the neuroma.
In the most severe cases, surgery may be recommended for patients who do not respond to conservative treatments. We can help you determine the best approach for your specific condition.
The following are some of the ways my patients have described the pain from a neuroma: “It feels like I’m stepping on a pebble,” “I feel like my sock is wadding up under the ball of my foot,” “I feel a burning pain between my toes,” and sometimes “my 3rd and 4th toes are numb – is it diabetes?” Well, it’s not diabetes (in most cases). It is most likely a common condition called a Morton’s Neuroma, something we podiatrists treat daily.
What exactly is a Neuroma?
It’s actually a bit of a misnomer. It is not a tumor at all. It is in fact a swollen, inflamed nerve located between the bones at the ball of the foot. It can be between the 2nd and 3rd toes or the 3rd and 4th toes. The nerve can actually become so enlarged that it pushes the toes apart when you stand up (called a Sullivan’s sign). It is seldom found between the big toe and 2nd toe or between the 4th and 5th toes.
Who gets it?
Mostly adults, but occasionally I have seen it in teens. Women are more likely to suffer from a neuroma. Perhaps due to the shoes they wear. High heels can cause the foot the slide down in the shoe and compresses the ball of the foot in the toe box. Participating in high-impact athletic activities such as jogging or running may subject your feet to repetitive trauma which can also lead to a neuroma. Foot deformities like bunions, hammertoes and flatfeet can also be predisposing factors.
So, how do we diagnose it?
In most cases, clinical findings alone are sufficient. A positive mulder sign is when the doctor squeezes the ball of the foot with one hand, while concomitantly putting pressure on the interdigital space (on the bottom of the foot between the two metatarsal bones) with the other hand. A click can be felt as well as pain in most cases. An ultrasound and/or MRI can also be used for diagnostic purposes, but the neuroma can sometimes be missed with these imaging studies.
How do we treat it?
A custom orthotic with a metatarsal pad included to relieve pressure from the neuroma is usually the first line treatment. Steroid injections can also be very helpful to decrease the inflammation. Another kind of injection called a sclerosing injection (alcohol based) can also be used to deaden the nerve. These injections are usually given in a series (every 10 days or so – anywhere from 5 to 10 total). If conservative care fails there are also surgical treatment options. There are two kinds of surgery for neuromas: one releases the ligament compressing the nerve and the other involves removing the nerve. Happily, most people recover with conservative care alone and do not need surgery but if conservative care fails surgery can be a welcome relief from the constant pain.