Aiko Vancil

Common Foot Problems

What Causes Mortons Neuroma

Overview

MortonMorton?s neuroma is inflammation, thickening, or enlargement of the nerve between the bones of the toes (metatarsal bones). The condition is also called intermetatarsal neuroma. The thickening is usually found between bones of the third and fourth toes of the foot, but sometimes it may develop between the second and third toes. It occurs when the medial plantar nerve near the bones of those toes becomes compressed or irritated, possibly because the metatarsal bones press against the nerve in the narrow gap between the toes. If left untreated, Morton?s neuroma can cause a sharp, burning, or shooting pain that often gets worse over time. The pain becomes worse when a person walks or stands on the ball of the foot. Sometimes the pain reaches the toes next to the neuroma and a sensation of tingling or numbness is felt.

Causes

Occupational hazards. Individuals whose jobs place undue stress on their forefeet (with or without wearing improper footwear) are among those who complain of neuromas. Podiatric physicians report that individuals who work on ladders, or who perform activities on their knees (such as doing landscaping, carpeting, flooring, or other work on the ground) are at risk for this problem, too, since these activities cause stress to the nerve near the ball of the foot. Those who engage in high-impact activities that bring repetitive trauma to the foot (running, aerobics, etc.) have a better than average chance of developing a neuroma at the site of a previous injury. To put it more simply, if you have sustained a previous injury to your foot (a sprain, stress fracture, etc.), that area of your foot will be more prone to neuroma development than an area that has not been injured. However, sports injuries aren?t automatically a ticket to neuromas. Trauma caused by other forms of injury to the foot (dropping heavy objects, for example) can also cause a neuroma to develop at the site of the previous injury. Much though we hate to say it, sometimes neuromas just develop and nobody knows why. The patient doesn?t have a previous injury, is wearing properly fitted shoes, and doesn?t stress his/her feet with any specific activity but the neuroma develops anyway. It is important to remember that some of the factors listed above can work alone, or in combination with each other, to contribute to the formation of neuroma.

Symptoms

What are the symptoms of Morton?s neuroma? A sharp or stinging pain between the toes when standing or walking. Pain in the forefoot between the toes. Swelling between the toes. Tingling (?pins and needles?) and numbness. Feeling like there is a ?bunched up sock? or a pebble or marble under the ball of the foot.

Diagnosis

In some cases your doctor will be able to feel the Morton's as a swelling in the middle of your foot. However they may also suggest an X-ray or a blood test - this is normally to rule our other causes of the pain such as arthritis. The most accurate way to diagnose Morton?s itself is with magnetic resonance imaging (MRI) or ultrasound.

Non Surgical Treatment

Relief of symptoms can often start by having a good pair of well fitting shoes fitted to your feet ensuring that the shoes don't squeeze your foot together. Once footwear is addressed patients may require a small pre-metatarsal pad to be positioned onto the insole of the shoe to help lift and separate the bones in the forefoot to alleviate the pressure on the nerve. If the patients foot structure and mechanics is found to be a contributing cause, a custom made orthotic is usually the most convenient and effective way to manage the problem. Sometimes an injection of local anaesthetic and steroid is recommended to assist in settling acute symptoms.intermetatarsal neuroma

Surgical Treatment

Surgery for neuroma most often involves removing affected nerve in the ball of the foot. An incision is made on the top of the foot and the nerve is carefully removed. Surgeon must remove the nerve far enough back so that the nerve doesn?t continue to become impinged at the ball of the foot. Alternatitvely, another type of surgery involves releasing a tight ligament that encases the nerve. Recovery after Morton?s neuroma (neurectomy) surgery is generally quick. Typically patients are walking on the operated foot in a post-surgical shoe for 2 - 4 weeks, depending on healing. Return to shoes is 2-6 weeks after the surgery. Factors that may prolong healing are age, smoking, poor nutritional status, and some medical problems.
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