Also referred to as Morton neuroma, Morton’s neuralgia, Morton’s metatarsalgia, intermetatarsal neuroma, interdigital neuroma or plantar neuroma, Morton’s neuroma is a benign neuroma affecting the intermetatarsal plantar nerve mostly the one located in the second and the third intermetatarsal spaces. This pain is mostly characterized by pain and sometimes numbness and is relieved by the removal of shoes. Despite the name, this condition was first described by a chiropodist by the name Durlacher. This condition bears the name neuroma but there are many sources that consider it a perineural fibroma which is the formation of fibrous tissues around the nerve tissue, as opposed to a true tumor.
Morton’s neuroma involves the thickening of the tissue surrounding one of the nerves that go to the toes. This condition is known to cause a sharp burning pain in the region of the ball of the foot. In some cases the toes might also get a burning or numbness sensation or a sting. Shoes with high heels have been linked to the development of Morton’s neuroma and most of the patients have reported pain relief after changing from high-heeled shoes to low shoes with a wider box for the toes.
Symptoms of Morton’s Neuroma
There are no outward signs reported in this condition. However, patients suffering from Morton’s neuroma report a feeling as though they have pebbles in their shoes. There is usually a burning pain in the ball of the foot and this might radiate to the toes. In some cases there is numbness and tingling experienced in the toes. Any individual that experiences foot pain for a number of days is advised to see a doctor. If there is a buring pain in the ball of the foot and this does not improve even after altering activities causing stress and changing foot wear, the affected individual should immediately see a health professional for diagnosis and treatment.
Most of the people suffering from Morton’s neuroma will feel anxious about placing their foot on the ground and walking. The pain is mostly likely to intensify with tight shoes and thus roomy shoes will help, so will rubbing the affected foot.
Causes of Morton’s Neuroma
The causes of Morton’s neuroma are not clearly understood but there are various things that are known to aggravate the condition. These may include the wearing of restrictive footwear and other foot related problems. It is believed that Morton’s neuroma might be as a result of the toe bones compressing the nerve when the gap between the bones is narrowed and this causes the thickening of the nerve and the surrounding tissue.
Foot wear that is excessively tight will worsen the pain caused by Morton’s neuroma. High heeled shoes that are over 2 inches with a pointed toe area will also compress the toes and worsen the pain. This is the main reason why Morton’s neuroma is common in women than in men.
Some medical experts have suggested that Morton’s neuroma might be linked to other foot problems. This is because the metatarsal bones might rub against the foot nerve as a result of these conditions which might include flat feet, bunions, high arches, abnormal position of the toes, and hammer toes. Sports and related activities are also known to worsen the Morton’s neuroma symptoms. Activities such as running and jogging can increase the pressure on the nerve and this can lead to the worsening of the symptoms.
There are various factors that have been found to contribute to the development of Morton’s neuroma. These factors include:
Sports – People who take part in high impact sporting activities such a running and jogging are at a greater risk of developing Morton’s neuroma. Sports that involve tightly fitting footwear such as rock climbing and skiing will put pressure on the toes and are likely to increase the risk of developing Morton’s neuroma.
High-heeled shoes – Wearing shoes with high heels or shoes that are tight, especially in the toe boxes will add extra pressure on the ball of the foot and might result in Morton’s neuroma.
Foot deformity – Deformities of the foot such as bunion, flatfeet, high arches and hammertoes put an individual at greater risk of suffering from Morton’s neuroma.
Morton’s Neuroma Diagnosis
Most physicians will use physical examination in the diagnostic process of Morton’s neuroma. During this examination, the doctor will put pressure on the affected foot to feel for a tender spot or a mass in the foot. The medical practitioner will also check for a clicking sound between the foot bones. Imaging tests might be used in the diagnosing Morton’s neuroma though it is a tissue related condition. The first imaging test that might be carried out is an x-ray which will assess the presence of arthritis and rule out fractures, or focal bone lesion which may have symptoms similar to Morton’s neuroma.
Ultrasound may be used to reveal the thickening of interdigital nerve in the web space greater than 3 millimeters. This usually occurs at the intermetatarsal ligament level. Other conditions that may be demonstrated using ultrasound include capsulitis, stress fracture, and the disruption of the plantar plate. Magnetic resonance imaging (MRI) may also be used in demonstrating the above conditions though ultra sound might have more benefits especially where there are different abnormalities. Ultrasound is also used in guided treatment such as alcohol ablation to the nerve or corticosteroid injections.
Morton’s Neuroma Treatment
The treatment direction followed when treating Morton’s neuroma will depend on the severity of the symptoms. The most recommended treatment is the use of conservative methods. Therapy will mostly be used and it involves the use of foot pads, and arch support which are aimed at reducing the pressure on the nerves. Corticosteroid and orthotics injections are commonly used as conservative treatments. These injections can relieve the pain and help in getting rid of the Morton’s neuroma symptoms.
If the conservative methods fail, then surgery may be used. Decompression surgery is a procedure that involves the relieving of the pressure affecting the nerve. This might involve the cutting of nearby structures and tissues such ligaments that bind the bones together.