Interdigital neuroma (Morton?s Neuroma) of the foot includes common, paroxysmal, neuralgia affecting the web spaces of the toes. It involves entrapment neuropathy (nerve compression) of the common digital nerve below and between the metatarsal heads, typically between the third and the fourth metatarsal heads. The pain is most commonly felt between the third and fourth toes but can also occur in the area between the second and third toes.
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.
Outward signs of Morton's neuroma, such as a lump, are extremely rare. Morton's neuroma signs and symptoms, which usually occur unexpectedly and tend to worsen over time, include, pain on weight bearing (while walking) - a shooting pain affecting the contiguous halves of two toes, which may be felt after only a short time (of weight bearing). Sometimes there may be a dull pain rather than a sharp one. Most commonly, pain is felt between the third and fourth toes. Typically, a patient will suddenly experience pain while walking and will have to stop and remove their shoe. Burning. Numbness. Parasthesia, tingling, pricking, or numbness with no apparent long-term physical effect. Commonly known as pins-and-needles. A sensation that something is inside the ball of the foot.
The doctor will ask about your symptoms and medical history. A physical exam will be done. Initial diagnosis of Morton's neuroma is based on your description of the type and location of pain and discomfort in the foot. The diagnosis will be confirmed by a physical exam of the foot, including checking for mechanical abnormalities in the foot, squeezing the side of the foot, which will usually cause pain when Morton's neuroma is present. Examination of your shoes to check for excess wear in parts of the shoe, check to see whether the shoes are too tight. Imaging tests evaluate the foot and surrounding structures. This may be done with X-ray, MRI scan, Ultrasound. Injections of local anesthetic can also be used for diagnosis.
Non Surgical Treatment
Pain is the main reason that you seek treatment for a neuroma. Analgesics may help. Inflammation it best eased via ice therapy and techniques or exercises that deload the inflammed structures. Anti-inflammatory medications may help. Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include: ice, electrotherapy, acupuncture, deloading taping techniques, soft tissue massage and orthotics to offload the irritated nerve. One of the biggest factors in relieving pain may be changing or modifying your footwear. This may mean adding felt, foam or gel products to your shoe to help offload the area, or looking at avoiding tight fitting heels or shoes.
Surgery for mortons neuroma consists of either a decompression, where more space is created for the nerve or a resection, where this part of the nerve is removed completely. This will result in some permanent minor numbness. Success rates for surgical procedures to treat mortons neuroma have a high success rate.