Jocelyn Hassinger

Foot Pain

Dealing With Mortons Neuroma

Overview

MortonMorton'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.

Causes

A Morton's neuroma commonly occurs due to repetitive weight bearing activity (such as walking or running) particularly when combined with tight fitting shoes or excessive pronation of the feet (i.e. "flat-feet"). The condition is also more common in patients with an unstable forefoot allowing excessive movement between the metatarsal bones. A Morton's neuroma can also occur due to certain foot deformities, trauma to the foot, or the presence of a ganglion or inflamed bursa in the region which may place compressive forces on the nerve.

Symptoms

While the condition may at first only appear during heavy repetitive stress or when wearing particular shoes which aggravate the foot, the Neuroma can become increasingly inflamed and produce more constant discomfort, lasting days or weeks. Runners may experience pain pushing off from starting blocks. Tight or narrow shoes as well as high heels likewise aggravate the Neuroma. A checklist of symptoms includes burning pain, occasionally numbness in the ball of the foot. Radiating pain from the ball of the foot to the toes. Intensifying pain during activity and when wearing shoes. Occasional numbness, discomfort, tingling or ?electrical shock sensation? in the toes. Pain between the third and fourth toes, often occurring from the outer side of one toe to the inner side of the adjoining toe. Pain upon leaving the starting blocks in running sports.

Diagnosis

Based on the physical examination, your doctor usually can diagnose a Morton's neuroma without additional testing. A foot X-ray may be ordered to make sure that there isn't a stress fracture, but it will not show the actual neuroma. If the diagnosis is in doubt, your doctor may request magnetic resonance imaging (MRI) of the foot.

Non Surgical Treatment

The most important factor in the treatment of Morton's neuroma is changing footwear. Sometimes a cushioned dome pad can be worn inside the shoe and this helps spread the metatarsal heads and decrease pressure on the nerve. There are other products that can be worn between the toes with certain types of shoes or when the client is barefoot. These toe spacers will help reverse biomechanical patterns that aggravate the nerve compression. Massage can be helpful, but should not be performed with deep pressure between the metatarsal heads. Additional pressure in this region can aggravate the nerve compression and prolong the pathology.intermetatarsal neuroma

Surgical Treatment

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.
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