A Morton's neuroma usually develops between the third and fourth toes. Less commonly, it develops between the second and third toes. Other locations are rare. It also is rare for a Morton's neuroma to develop in both feet at the same time. The condition is much more common in women than men, probably as a result of wearing high-heeled, narrow-toed shoes. This style of shoe tends to shift the bones of the feet into an abnormal position, which increases the risk that a neuroma will form. Being overweight also increases the risk of a Morton's neuroma.
Although in many areas of medicine, it?s easy to pinpoint the exact source of a problem (the way a specific germ causes a certain illness with recognizable symptoms), neuromas are harder to categorize. While there isn?t really one exact cause, podiatric physicians tend to agree that a neuroma can occur in response to the irritation of a nerve by one or more factors. Abnormality in foot function or foot mechanics: In other words, a foot that doesn?t move the way science thinks it should. In general, this means a pronated foot (one with an excessive rolling motion when the patient is walking, running or doing any kind of activity), because it causes excessive strain on the nerve. If you are not certain whether or not this is a problem for you, ask your podiatric physician, who will be able to examine your feet, as well as the wear pattern on your shoe, and give you an answer. Foot mechanics, and problems with them, tend to run in families, so if you know that a relative has had foot pain similar to yours, be sure to mention it.
You may initially experience a tingling sensation in the space between your toes, which gets worse over time. This leads to cramp in your toes and a sharp shooting or burning pain on the ball of your foot or at the base of your toes. The pain is often worse when walking or wearing shoes that press on the affected area. This is caused by irritation of the nerve between your toe bones (metatarsal bones). The tingling will eventually lead to pain, which can get worse over time. You may also experience cramping of your toes. The pain is usually felt as a sharp shooting or burning pain on the ball of the foot or at the base of the toes, which is often made worse when you're walking. Some people with Morton's neuroma feel anxious about walking or even placing their foot on the ground. The pain is likely to be more intense if you wear tight shoes, so wearing shoes that have more room in the toe area can help. Rubbing your foot may also lessen the pain.
Morton?s neuroma can be identified during a physical exam, after pressing on the bottom of the foot. This maneuver usually reproduces the patient?s pain. MRI and ultrasound are imaging studiesthat can demonstrate the presence of the neuroma. An x-ray may also be ordered to make sure no other issues exist in the foot. A local anesthetic injection along the neuroma may temporarily abolish the pain, and help confirm the diagnosis.
Non Surgical Treatment
Treatment options vary with the severity of each neuroma, and identifying the neuroma early in its development is important to avoid surgical correction. For simple, undeveloped neuromas, a pair of thick-soled shoes with a wide toe box is often adequate treatment to relieve symptoms, allowing the condition to diminish on its own. For more severe conditions, however, additional treatment or surgery may be necessary to remove the tumor. The primary goal of most early treatment regimens is to relieve pressure on areas where a neuroma develops. Your podiatric physician will examine and likely X-ray the affected area and suggest a treatment plan that best suits your individual case. Padding and Taping. Special padding at the ball of the foot may change the abnormal foot function and relieve the symptoms caused by the neuroma. Medication. Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the neuroma. Orthotics. Custom shoe inserts made by your podiatrist may be useful in controlling foot function. Orthotics may reduce symptoms and prevent the worsening of the condition.
Majority of publications including peer review journal articles, surgical technique description and textbooks promote surgical excision as a gold standard treatment. Surgical excision is described as the most definitive mode of treatment for symptomatic Morton?s neuroma with reported success rates varying between 79% and 93%. Various surgical techniques are described, essentially categorised as dorsal versus plantar incision approaches. Beyond this the commonest technical variation described as influencing the outcome of surgery involves burying and anchoring transacted nerve into soft tissue such as muscle.