Morton's Neuroma, also called intermetatarsal neuroma, is a painful condition affecting the ball of your feet. It mostly affects the section between the 3rd and 4th toes. At first, it feels as if a pebble is lodged between your toes, or you are actually standing on one. Patients suffering from this condition experience pain and numbness in the affected area. This discomfort is relieved when you remove the shoes or massage the foot.
A neuroma is a non-cancerous tumor that begins in the nerve cells. This benign growth can develop in different parts of the body. When you are suffering from Morton’s neuroma, the tissues surrounding one of the nerves that leads to the toes thickens. This results to a burning and sharp pain, experienced at the ball of the foot. The pain can sometimes be described as a hot red needle, due to the manner in which it occurs. It can occur suddenly when walking.
Apart from the pain, you may experience burning, stinging and numbness in the toes. As much as it’s described as a neuroma, most medical experts hold the belief that it is not a real tumor but instead a fibrous tissue forming around the nerves. It may occur due to injury, pressure, or irritation. In some cases, the cause may not be clear. It mainly affects one nerve. Only in rare cases are both feet affected.
The condition can occur in any age. However, most patients suffering from this condition are women, mainly due to wearing narrow or high-heeled shoes, which place pressure on the feet. It is also common with runners, mainly because of the extra pressure exerted on the toes when running. Patients with this disorder may have to take steroid injections, painkillers, and change their footwear. Surgery might be needed in extreme cases where the affected nerve is removed or releasing pressure on the nerve.
What Causes Morton's Neuroma?
The exact causes of Morton’s neuroma are not clear. However, most experts believe that it develops due to irritation, injury or pressure, on one of the nerves leading to the toes. When this happens, a response is triggered, which results in thickened nerve tissue. The bones can rub against the nerves, due to various pre-disposing situations and conditions. These include:
This is a deformity occurring within a joint of the 2nd, 3rd or 4th toe, which causes it to be bent permanently.
High Impact Sports Activities
Think of court sports, running and karate. Any activity or sport that places additional pressure on the foot can lead to Morton’s neuroma. Sports that also involved wearing tight shoes like rock climbing and snow skiing can exert pressure on your feet.
This is the main cause of this foot condition. Shoes with a heel of over 5 cm, as well as those with a pointed and tight toe box that smashes the toes together present a high risk of this condition. That can be the reason why the condition is highly prevalent among women.
If your sole comes into contact or near contact with the ground, then you are exposing your feet to a possible case of Morton’s neuroma.
Without proper arch support, people with high arches tend to place undue pressure on the ball of the feet, especially when they engage in high impact activities like running. When this happens continuously, it might lead to Morton’s neuroma.
Symptoms of Morton's Neuroma
Unlike other foot diseases, outward signs of this condition are not common. The signs and symptoms develop gradually, then worsen with time if the condition is not attended to within reasonable timelines. Some of the symptoms associated with Morton’s neuroma include:
1. A sensation or discomfort as if there is an object inside the ball of your foot
4. Paresthesia - This is pricking, numbness, or tingling without any long-term physical effects. This is commonly called pins-and-needles
5. Pain when weight bearing – a shooting pain that affects the touching sides of the 3rd and 4th toe immediately you start walking. The pain may be dull sometimes, instead of a sharp sensation. Most patients will stop and remove the shoe, and the pain seems to go away.
Many individuals with this condition describe it as a burning sensation in the ball of the foot, which then spreads to the toes. The pain becomes even more pronounced when the individual wears narrow, high-heeled, or tight shoes. The person may also experience the burning sensation engaging in activities that exert pressure on the foot. After the burning sensation, the pain seems to stay longer and may continue up to a week. After several weeks, they symptoms become severe, making it extremely difficult to walk, even over short distances.
How is Morton's Neuroma Diagnosed?
A podiatrist will ask you to describe the pain, its intensity, types of shoes worn, when the symptoms started as well as questions related to your lifestyle, job and hobbies. The podiatrist then proceeds to examine the affected foot then tries to isolate the affected nerve. During this stage, the foot specialist will manipulate your foot, to try and reproduce the symptoms. The podiatrist might also perform a process known as maneuver, meant to produce a clicking sound between the toes. If the sound is produced, there is a high possibility that you are suffering from Morton’s neuroma. In order to obtain a detailed view of the interior of the foot, some scans may be conducted, which include:
To try to determine the actual problem. Metatarsophalangeal joint synovitis is sometimes misdiagnosed as Morton’s neuroma. Therefore, X-rays are very useful in ruling out other foot conditions.
These types of scans are reliable diagnostic tools for this foot condition since they don’t require any radiation, they are affordable and are very accurate in identifying Morton’s neuroma. In fact, their accuracy level is almost similar to MRI scans. Ultrasound scans also help to differentiate Morton’s neuroma from other common foot conditions.
These are more expensive than both X-rays and ultrasound scans. However, they are very efficient in detecting Morton’s neuroma, even when in patients where the symptoms are mild or yet to be felt.
Other conditions that are usually misdiagnosed as Morton’s neuroma include hammertoes, metatarsalgia, rheumatoid arthritis together with other systemic arthritis, metatarsal heads and stress fractures on the metatarsal neck.
What Treatment for Morton's Neuroma?
The treatment approach used is dependent on various factors. This includes the duration of the symptoms, as well as the severity of the problem. When the condition is diagnosed early enough, it will be easy to treat using non-invasive methods. The treatment options available are surgical management and conservative approaches.
The conservative approach involves the use of a physical therapist. The therapist can then guide the physician and the patient in modification of footwear as well as the treatment method to be pursued. He or she may recommend low-heeled shoes with a wide toe box. Non-padded, narrow, or high-heeled shoes should be avoided at all costs during the conservative management period, since they will just aggravate the situation. The next step during conservative management is altering the alignment of your metatarsal heads.
The metatarsal head close to the neuroma may be elevated or slightly raised. This approach prevents compression and irritation occurring to the digital nerve. This elevation involves the use of a plantar pad. The patient is asked to insert a gel or felt pad into the shoe, which helps to obtain the desired elevation. Other physical therapy treatment approaches that can be pursued for patients with this foot condition include:
• Bodyweight management – if you are overweight or obese, the doctor may advise you to cut down some weight. Most obese patients suffer from foot problems like flat feet. If you manage to lose weight successfully, then you will notice an improvement in the symptoms.
• Modifying activities – This involves avoiding activities that lead to continous pressure on the neuroma until an improvement has been observed. For example, you can take a break from physically demanding activities like running.
• Changing footwear – If you are used to wearing high-heeled and narrow shoes, then you should change over to lower shoes with sufficient padding. This change will minimize the pressure on your feet and provide the necessary support need to keep your feet properly aligned.
• Applying ice packs on the affected area – Ensure that you don’t expose your skin directly to the ice. The ice should be wrapped up or inside a container.
• Massaging the foot and the affected toes.
Most approaches used in physical therapy, are usually meant to reduce the pressure on the foot and minimize the pain.
If symptoms and the pain persists, the doctor may have to recommend alternative treatment methods. They include:
• Alcohol sclerosing injections – use of alcohol injections helps in alleviating the pain, while reducing the size of Morton's neuroma. This therapy is relatively new, and is yet to spread to most parts of the world. The physician injects alcohol, directly into the section affected by Morton's neuroma. The alcohol helps to harden the nerve while relieving pain. These injections are usually administered every 10 days. To get maximum relief, the patient will require a minimum of 4 to 7 injections.
• Corticosteroid injections – these are steroid medications used to reduce inflammation and pain. They are also injected into the area affected by Morton’s neuroma. Due to their side effects, only a few injections are administered. Potential side effects include weight gain and high blood pressure.
Once conservative measures of treating this condition have failed or unsuccessful, surgical intervention might be the only option. A surgical excision of the area affected by Morton’s neuroma can be curative. Some of the procedures available include:
• Removal of the nerve – Your doctor might suggest surgical removal of the nerve when other treatment options have failed to provide relief. As much as surgery is always successful, it might lead to permanent numbness in the affected area.
• Decompression surgery – in some instances, surgeons might opt to relieve pressure on the affected area by cutting adjacent structures, like the ligament binding together the bones at the forefoot.
The surgical excision may be conducted using two approaches. These are the plantar approach and the dorsal approach. During the plantar approach the surgeon creates an incision underfoot. In most instances, the patient will only need to use crutches for around three weeks.
Walking may be painful or uncomfortable, due to the resultant scar. As much as this approach takes longer to heal, it is more effective and less invasive, since the neuroma can be reached without cutting adjacent structures. However, there is a minor risk of infection after surgery, especially around the toes. On the other hand, the dorsal approach involves an incision made at the top of the foot. The patient can walk immediately after the surgical procedure, since the stitches made are opposite the weight-bearing side.
How Can You Prevent Morton's Neuroma?
The first step when it comes to preventing Morton's neuroma, is wearing the right type of shoes. High-heeled shoes are a fashion statement among ladies. However, they can also lead to various foot problems, including Morton's neuroma. Whenever you wear high heels, there is improper alignment of the foot. Apart from that, undue pressure is exerted on the metatarsals, as well as the ball of the foot. This weight bearing leads to various foot conditions.
Therefore, if you must wear high heels, don’t make it an everyday affair. Instead, alternate between high heels and flats. Moreover, wear heels with a reasonable height. The higher the heels, the higher the pressure being placed on your feet, thus increasing chances of Morton's neuroma. When it comes to footwear selection, you also need to make sure that your shoes have the right amount of padding and shock absorption. Therefore, any amount of stress or strain will not be transferred to your feet.
Apart from wearing high-heeled shoes, Morton's neuroma can also be caused by various foot conditions like bunions, hammertoes, and high arches. This means that it is not entirely avoidable. However, you can minimize the risks by wearing proper footwear.