Morton’s Neuroma is a common foot problem associated with pain, swelling and/or an inflammation of a nerve, usually at the ball-of-the-foot between the 3rd and 4th toes. 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.
Some say that this condition should not be called Morton’s neuroma as, in fact, it is not actually a neuroma. A neuroma is a non-cancerous (benign) tumour that grows from the fibrous coverings of a nerve. There is no tumour formation in Morton’s neuroma. The anatomy of the bones of the foot is also thought to contribute to the development of Morton’s neuroma. For example, the space between the long bones (metatarsals) in the foot is narrower between the second and third, and between the third and fourth metatarsals. This means that the nerves that run between these metatarsals are more likely to be compressed and irritated. Wearing narrow shoes can make this compression worse.
Neuroma pain is classically described as a burning pain in the forefoot. It can also be felt as an aching or shooting pain in the forefoot. Patients with this problem frequently say they feel like they want to take off their shoes and rub their foot. This pain may occur in the middle of a run or at the end of a long run. If your shoes are quite tight or the neuroma is very large, the pain may be present even when walking. Occasionally a sensation of numbness is felt in addition to the pain or even before the pain appears.
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a Morton’s neuroma. Investigations such as an X-ray, ultrasound, MRI, CT scan or bone scan may sometimes be used to assist with diagnosis, assess the severity of the injury and rule out other conditions.
Non Surgical Treatment
Conservative treatment involves a reduction in the inflammation and removing the impingement factor. Reduction in inflammation is achieved via rest, elevation, ice, and massage with anti-inflammatory gels. Removing foot wear and and/r wearing broad type footwear would also help. Injection therapy is useful in reducing symptoms but not very successful in providing long term relief. The only time when it is most appropriate is when the cause of the space occupying object is not a neuroma but an inflamed bursa. Injection would help to relieve symptoms, and often cortisone is not even necessary.
The ultimate success of a Morton?s neuroma treated surgically can be variable. In cases where the underlying problem is only an irritated nerve (a true Morton?s neuroma), then surgery will probably be curative (although it may take a few months for the foot to fully heal). But in many cases, forefoot pain is more complex. There may be an irritated nerve or two causing pain, but the real problem is often excessive loading of the lesser metatarsals. The generic term for this condition is metatarsalgia. When considering surgery, identifying and addressing these problems may lead to a better end result.