Morton’s neuroma
Morton’s neuroma is a painful condition that affects the ball of your foot, most commonly the area between your third and fourth toes. Morton’s neuroma may feel as if you are standing on a pebble in your shoe or on a fold in your sock.
Morton’s neuroma involves a thickening of the tissue around one of the nerves leading to your toes. This can cause a sharp, burning pain in the ball of your foot. Your toes also may sting, burn or feel numb.
High-heeled shoes have been linked to the development of Morton’s neuroma. Many people experience relief by switching to lower heeled shoes with wider toe boxes. Sometimes corticosteroid injections or surgery may be necessary.
Symptoms
Typically, there’s no outward sign of this condition, such as a lump. Instead, you may experience the following symptoms:
- A feeling as if you’re standing on a pebble in your shoe
- A burning pain in the ball of your foot that may radiate into your toes
- Tingling or numbness in your toes
When to see a doctor
It’s best not to ignore any foot pain that lasts longer than a few days. See your doctor if you experience a burning pain in the ball of your foot that’s not improving, despite changing your footwear and modifying activities that may cause stress to your foot.
Causes
Morton’s neuroma seems to occur in response to irritation, pressure or injury to one of the nerves that lead to your toes.
Risk factors
Factors that appear to contribute to Morton’s neuroma include:
- High heels.Wearing high-heeled shoes or shoes that are tight or ill-fitting can place extra pressure on your toes and the ball of your foot.
- Certain sports.Participating in high-impact athletic activities such as jogging or running may subject your feet to repetitive trauma. Sports that feature tight shoes, such as snow skiing or rock climbing, can put pressure on your toes.
- Foot deformities.People who have bunions, hammertoes, high arches or flatfeet are at higher risk of developing Morton’s neuroma.
Diagnosis
During the exam, your doctor will press on your foot to feel for a mass or tender spot. There may also be a feeling of “clicking” between the bones of your foot. This is the so-called Mulder’s Click.
Imaging tests
Some imaging tests are more useful than others in the diagnosis of Morton’s neuroma:
- X-rays.Your doctor is likely to order X-rays of your foot, to rule out other causes of your pain — such as a stress fracture.
- This technology uses sound waves to create real-time images of internal structures. Ultrasound is particularly good at revealing soft tissue abnormalities, such as neuromas. Small neuromas measure less than 5mm thick and usually respond to just cortisone injections. Medium sized neuromas are 5-10mm thick and often need the alcohol injections after the cortisone to conquer the pain. It is not surprising that large neuromas, great than 1 cm in diameter, resist both the cortisone and the alcohol and need surgical removal. We always start with the most conservative and least costly method first, that is, the cortisone injection(s).
- Magnetic resonance imaging (MRI).Using radio waves and a strong magnetic field, an MRI also is good at visualizing soft tissues. But it’s an expensive test and often indicates neuromas in people who have no symptoms. We are most likely to order an MRI if we are contemplating surgery.
Treatment
Treatment depends on the severity of your symptoms. Your doctor will likely recommend trying conservative approaches first.
Therapy
Arch supports and foot pads fit inside your shoe and help reduce pressure on the nerve. These can be purchased over-the-counter, or your doctor may prescribe a custom-made, individually designed shoe insert — molded to fit the exact contours of your foot.
Surgical and other procedures
If conservative treatments haven’t helped, your doctor might suggest:
- Some people are helped by the injection of steroids into the painful area.
- Alcohol injections If up to three cortisone injections do not relieve you of your pain you might elect a series of 7 or 8 injections of 4% alcohol. This concentration of alcohol can “kill” or reduce the pain of the nerve without affecting the surrounding tissues like the bone or tendons. Most people find that this series of alcohol injection eliminated the need for surgery.
- Removal of the nerve.Surgical removal of the growth may be necessary if other treatments fail to provide pain relief. Although surgery is usually successful, the procedure can result in permanent numbness in the affected toes. Complete numbness is rare and some feeling returns after a year. The overwhelming majority of patients find the numbness preferable to the pain.
Partial information provided by Mayo clinic (mayoclinic.org)