Morton's Neuroma
Synonyms and Keywords Mortons Neuroma, Morton’s metatarsalgia, plantar nueroma, intermetatarsal neuroma, Morton’s Nueralgia.
What is Morton's Neuroma?
A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton’s neuroma, which occurs between the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma. “Intermetatarsal” describes its location in the ball of the foot between the metatarsal bones. Neuromas may also occur in other locations in the foot. The Morton’s Neuroma is also caused because the spot where the nerves meet inside the subcutaneous tissue is close to an artery and vein and is also above the fat pad of the foot. The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage.
Nerves can become entangled and bunched creating something resembling a benign tumor. The bunching of nerves is referred to as a neuroma. This syndrome occurs more often in women than in men.
What you actually feel with Morton’s Neuroma is a sharp, burning pain in the ball of your foot or a sting burning feeling in your toes. Your toes might even feel numb at times.
Symptoms of this condition include sharp pain, burning, and even a lack of feeling in the affected area. Morton's Neuroma may also cause numbness, tingling, or cramping in the forefoot.
What Causes Morton's Neuroma?
Anything that causes compression or irritation of the nerve can lead to a neuroma. One of the most common culprits is wearing shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box. As you walk, the ground pushes the inflamed nerve up, and the deep transverse metatarsal ligament down, causing compression.
Symptoms of Morton's Neuroma often occur during or after you have been placing significant pressure on the area, while walking, standing, jumping, or sprinting. This condition can also be caused by footwear selection. Footwear with pointed toes and/or high heels can often lead to a neuroma. Constricting shoes can pinch the nerve between the toes, causing discomfort and extreme pain.
Who Gets Morton's Neuroma?
Most often, women who regularly wear high-heel shoes are at the greatest risk of developing Morton's neuroma.
People with certain foot deformities – bunions, hammertoes, flat feet, or more flexible feet – are at higher risk for developing a neuroma.
Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or certain sports. An injury or other type of trauma to the area may also lead to a neuroma.
Are There Different Types of Morton's Neuroma?
The medical name for Morton's neuroma is intermetatarsal neuroma, because it generally occurs between the third and fourth metatarsarsal toe bones.
Morton's neuroma can also develop in other parts of the foot. In this condition, repeated irritation or compression of the plantar nerve leads to swelling or thickening of the nerve and, eventually causing nerve damage. The mass that grows between the metatarsals is noncancerous but can cause pain, numbness, a tingling or burning sensation, or the feeling that a small pebble is lodged under the ball of the foot.
What Are the Symptoms of Morton's Neuroma?
If you have a Morton’s neuroma, you may have one or more of these symptoms where the nerve damage is occurring:
- Burning sensation: This inflamed feeling in the foot is one of the most common signs of Morton’s Neuroma.
- Pain: The front pad on the bottom of the foot can become extremely sore at the end of a long day or after exercise. In severe cases, the pain may even occur while walking normally or even during rest. The pain can be accompanied by a feeling of numbness in your foot. The numbness may come with the pain or sometimes even before the pain comes in. In the case of Morton’s Neuroma, a session of night pain is usually rare. Pain attacks come generally when you move around more and especially when you are in tight shoes. The symptoms generally do not come all of a sudden. They progress quite gradually. It may first occur only when you are wearing uncomfortable shoes or undertaking on any overly aggressive activity.
- Feeling of a stone in your shoe: or a sock bunched up in your shoe is quite common. Applying pressure to area can result in a sharp and immobilizing pain. Some studies have shown that Morton’s Neuroma may be just as painful as childbirth.
- The symptoms begin gradually: At first you might notice pain or numbness only occasionally, most often when wearing narrow-toed shoes or performing certain activities The symptoms may go away temporarily by removing the shoe, massaging the foot, or by avoiding aggravating shoes or activities. Over time the symptoms progressively worsen and may persist for several days or weeks. The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.
How do you Diagnose Morton's Neuroma?
To arrive at a diagnosis, the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor will attempt to reproduce your symptoms by manipulating your foot.
Physical exam: Morton's neuroma is diagnosed by palpating the area and pressing the toes from one side to another in order to re-create the pain symptoms you are experiencing.
X-ray: The doctor will likely request an x-ray to rule out fractures and other causes such as arthritis.
MRI scan: May also be requested to rule out tumors and determine the size of the neuroma. The MRI also helps the doctor decide if surgery is necessary or not.
How do you Treat Morton's Neuroma?
In developing a treatment plan, your foot and ankle surgeon will first determine how long you’ve had the neuroma and evaluate its stage of development. Treatment approaches vary according to the severity of the problem.
Conservative Treatments
- Padding: Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
- Icing: Placing an icepack on the affected area helps reduce swelling.
- Orthotic devices: Custom orthotic devices provided by your foot and ankle surgeon provide the support needed to reduce pressure and compression on the nerve.
- Activity modifications: Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
- Shoe modifications: Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.
- Medications: Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
- Injection therapy: Treatment may include injections of cortisone, local anesthetics or other agents.
Self-care at Home
- Anti-Inflammatories Over the counter medications like Advil or Aleve or herbal anti-inflammation pills can help relieve pain and pressure. Make sure you are healthy enough to take these medications as they carry their own risks also.
- Ice. Ice can reduce swelling and dull pain. Freeze a water bottle and roll that over your foot for 20 minutes three times a day. This massaging action can help stimulate tissue as well
- Get New Shoes. Stop wearing shoes that have raised heels. Also, shoes must have ample room in the toes and not be confining at all. So flat shoes with wide widths would be perfect.
- Try an Arch Support or Shoe Insert – Custom arch supports may relieve the pressure on the nerve by supporting the other parts of your foot and reducing pressure. Some physicians also recommend a metatarsal pad or bar. Over the counter shoe inserts can also be effective for pain.
- Rest – Reduce your physical activities greatly and rest your feet and legs. Stop dancing, running, jogging, or anything that is high impact on your feet
Types of Morton's Neuroma Surgical Treatments
Morton’s Neuroma is a common disease entity of foot. It is seen to have a presence in females more than males. Though there are conservative lines of treatment available for the same, the Morton’s Neuroma can be best solved only by surgery in some cases. Conservative treatment may fail to give relief to some patients with increased difficulties. In such cases, there is an option of two lines of surgery the patient could be asked to undergo.
- Dorsal Surgery: An incision is made on the upper part of the foot, cutting the deep transverse metatarsal ligament to relieve the nerve block. A dorsal approach may cause forefoot instability, however. The good part of this surgery is that the patient does not need to use any support to walk after this surgery. This procedure will also leave the healthier tissue for secondary surgery, in case it may be required. Dorsal surgery may lead to instability in the foot that may require additional surgical treatments in the future.
- Plantar Surgery: An incision is made on the sole of the foot to repair the damage. The surgery requires weeks of healing and keeping weight off of the bottom of the foot. There may be discomfort from the scars on thesole of the foot. However, this method of surgery is still more often recommended than dorsal treatment, as it allows better access to the neuroma and helps to make resects without cutting any structures in the process.
Prior to Surgery
You are about to have surgery. As you may already know, nutrition plays a very important role in proper healing. One of the most important benefits of proper nutrition is maintaining a right pH balance in your body. pH is the measurement of acidity and alkalinity. pH ranges are from one to fourteen with fourteen representing most alkaline. Seven is neutral. The most optimal pH level for humans is slightly more alkaline than acidic at around 7.36.
Undergoing surgery can increase acid levels in the body. Emotional and physical stress from both the surgery and recovery time changes your metabolism, which increases acid production. The use of both general and local anesthesia, pain medication, anti-inflammatory medications and other medications such as antibiotics will also introduce more acid to your system, lowering the alkalinity. This will delay healing and prolong recovery time.
To maintain your body's proper pH, keep yourself well hydrated prior to and after surgery. Water helps to dilute the acid build up in your body and release it through urination. Eating alkaline rich foods such as dark, leafy green vegetables will add alkalinity. Avoid acidic foods such as meats, fried foods, coffee (and other caffeinated drinks), carbonated beverages, cigarettes and alcohol.
Other pre-operative considerations:
- Many people may need medical clearance through their Primary Care Physician, especially if taking medications such as Coumadin.
- Stop using anti-inflammatory medication five to seven days before surgery. These include: aspirin, ibuprofen (Advil), and naproxen sodium (Aleve).
- Arrange for a ride home from surgery and for someone to look after you for at least the first 24 hours.
- Avoid long trips for at least two weeks after surgery.
- Avoid eating and drinking anything after midnight the night before surgery.
Day of Surgery
Most foot and ankle surgeries are day surgeries, which mean you will go home the day of surgery. You will generally be given a local anesthetic and anesthesia. After surgery you will receive pain medication and care instructions.
Post-op Recovery
The best results and quickest healing is achieved when patients follow after surgery instructions.
- Keep your foot elevated as much as possible for the first week after surgery.
- Keep your foot dry for at least 2 weeks after surgery.
- One week after surgery you will have your dressing changed by coming to see your attending physician.
- The sutures will be removed after the second week.
- Your doctor will advise you when you can increase weight and activities on the foot.
- Take pain and anti-inflammatory medications as prescribed by your physician.
- Vitamin C is important to heal scar tissue. It is vital in aiding in collagen formation. Take 4,000 mg spread out over each day in 500 mg doses taken for several days to several weeks after surgery.
- Omega 3 fatty acids, such as flax or fish oil, vitamin A and beta-carotene aid in the skin healing and lessen the appearance of scars.
How to prevent Morton's Neuroma?
- Change your footwear, opting for shoes that do not compress the feat. Wear high toe box and wide shoes to prevent pressure, which will cause the deformity. Avoid wearing tight-fitting, narrow or pointed toe shoes, such as women's high heels or pumps.
- Rest, stretch and massage your feet regularly, especially after spending a long time in shoes or athletic activity, to take pressure off of the foot and the nerves.
- Wear foot pads, which will raise and spread the bones of the forefoot taking the pressure off the nerve. Treat existing foot problems such as high arches or flat feet. Padding and orthotics for these conditions can prevent the development of Morton's neuroma.
- Regularly visit your podiatrist to insure proper foot health.
