Overview
A morton's neuroma (or an "inter-digital" neuroma) is found between the toes of the foot, most commonly the third and fourth toes. It can also occur between the metatarsal bones (the long bones in the forefoot). It is basically an entrapped nerve, which becomes inflamed due to constant irritation from the surrounding bony structures.
Causes
The exact cause of Morton?s neuroma is not known, but the choice of footwear seems be a factor. Wearing high heels (shoes with heels over 2 inches) can put extra pressure on the balls of the feet. Wearing tight or pointed toed shoes may squeeze the toes together or otherwise constrict their movement. For that reason, women are about 8 to 10 times more likely to develop Morton?s neuroma compared with men. People who are born with flat feet, high arches, or an abnormal position of the toes are more prone to developing Morton?s neuroma. This may be due to instability around the toe joints. Certain conditions that develop over time, such as bunions or hammer toes, are also associated with Morton?s neuroma. Some sports that involve running, including tennis and other racquet sports, can also increase the chance of developing Morton?s neuroma due to trauma or injury to the foot.
Symptoms
Symptoms of interdigital neuroma typically manifest as a sharp, burning or tingling sensation in the forefoot. The pain radiates toward the lesser toes and is aggravated by shoe wear. The pain is relieved when the shoe is removed and the forefoot is massaged. Sometimes the symptoms involve specific toes.
Diagnosis
The physician will make the diagnosis of Morton's neuroma based upon the patient's symptoms as described above in an interview, or history, and a physical examination. The physical examination will reveal exceptional tenderness in the involved interspace when the nerve area is pressed on the bottom of the foot. As the interspace is palpated, and pressure is applied from the top to the bottom of the foot, a click can sometimes be felt which reproduces the patient's pain. This is known as a Mulder's sign. Because of inconsistent results, imaging studies such as MRI or ultrasound scanning are not useful diagnostic tools for Morton's neuroma. Thus the physician must rely exclusively on the patient's history and physical examination in order to make a diagnosis.
Non Surgical Treatment
If you have Morton's neuroma, shoes with a wider toe area may be recommended. You can also take painkillers to help ease the pain. Steroid injections may also be given to treat the affected nerve. If these treatments don't work, surgery may be needed. This involves removing the thickened tissue around the nerve (and sometimes the nerve itself) to release the pressure.
Surgical Treatment
Surgery to excise the neuroma is usually performed under general anaesthetic in a day surgery facility. After surgery you will have to keep your foot dry for two weeks. Generally neuroma surgery allows for early weight bearing and protection in some type of post op shoe gear. Some neuromas may reoccur, but this is rare. Most studies on patient satisfaction after neuroma surgery show approximately 90% reduction of pain and about 85% of all patients rated the overall satisfaction with the results as excellent or good.
A morton's neuroma (or an "inter-digital" neuroma) is found between the toes of the foot, most commonly the third and fourth toes. It can also occur between the metatarsal bones (the long bones in the forefoot). It is basically an entrapped nerve, which becomes inflamed due to constant irritation from the surrounding bony structures.
Causes
The exact cause of Morton?s neuroma is not known, but the choice of footwear seems be a factor. Wearing high heels (shoes with heels over 2 inches) can put extra pressure on the balls of the feet. Wearing tight or pointed toed shoes may squeeze the toes together or otherwise constrict their movement. For that reason, women are about 8 to 10 times more likely to develop Morton?s neuroma compared with men. People who are born with flat feet, high arches, or an abnormal position of the toes are more prone to developing Morton?s neuroma. This may be due to instability around the toe joints. Certain conditions that develop over time, such as bunions or hammer toes, are also associated with Morton?s neuroma. Some sports that involve running, including tennis and other racquet sports, can also increase the chance of developing Morton?s neuroma due to trauma or injury to the foot.
Symptoms
Symptoms of interdigital neuroma typically manifest as a sharp, burning or tingling sensation in the forefoot. The pain radiates toward the lesser toes and is aggravated by shoe wear. The pain is relieved when the shoe is removed and the forefoot is massaged. Sometimes the symptoms involve specific toes.
Diagnosis
The physician will make the diagnosis of Morton's neuroma based upon the patient's symptoms as described above in an interview, or history, and a physical examination. The physical examination will reveal exceptional tenderness in the involved interspace when the nerve area is pressed on the bottom of the foot. As the interspace is palpated, and pressure is applied from the top to the bottom of the foot, a click can sometimes be felt which reproduces the patient's pain. This is known as a Mulder's sign. Because of inconsistent results, imaging studies such as MRI or ultrasound scanning are not useful diagnostic tools for Morton's neuroma. Thus the physician must rely exclusively on the patient's history and physical examination in order to make a diagnosis.
Non Surgical Treatment
If you have Morton's neuroma, shoes with a wider toe area may be recommended. You can also take painkillers to help ease the pain. Steroid injections may also be given to treat the affected nerve. If these treatments don't work, surgery may be needed. This involves removing the thickened tissue around the nerve (and sometimes the nerve itself) to release the pressure.
Surgical Treatment
Surgery to excise the neuroma is usually performed under general anaesthetic in a day surgery facility. After surgery you will have to keep your foot dry for two weeks. Generally neuroma surgery allows for early weight bearing and protection in some type of post op shoe gear. Some neuromas may reoccur, but this is rare. Most studies on patient satisfaction after neuroma surgery show approximately 90% reduction of pain and about 85% of all patients rated the overall satisfaction with the results as excellent or good.