Overview
A neuroma is an often painful enlargement of one of your body?s nerves. Morton?s neuroma is the name used to describe nerve enlargement in your foot, particularly enlargement of one of the nerves traveling to your toes in your forefoot. Morton?s neuromas most commonly develop in one of your intermetatarsal nerves, one of many nerve branches within your foot that originated in your spine. Morton?s neuroma is more likely to affect women than men.
Causes
The exact cause is unknown. Doctors believe the following may play a role in the development of this condition. Wearing tight shoes and high heels. Abnormal positioning of toes. Flat feet. Forefoot problems, including bunions and hammer toes. High foot arches. Morton neuroma is more common in women than in men.
Symptoms
People with Morton's neuroma usually complain of pain that can start in the ball of the foot and shoot into the affected toes. However, some people just have toe pain. There may also be burning and tingling of the toes. The symptoms are usually felt up the sides of the space between two toes. For example, if the nerve between the third and fourth long bones (metatarsals) of the right foot is affected, the symptoms will usually be felt up the right-hand side of the fourth toe and up the left-hand side of the third toe. Some people describe the pain that they feel as being like walking on a stone or a marble. Symptoms can be made worse if you wear high-heeled shoes. The pain is relieved by taking your shoe off, resting your foot and massaging the area. You may also experience some numbness between the affected toes. Your affected toes may also appear to be spread apart, which doctors refer to as the 'V sign'. The symptoms can vary and may come and go over a number of years. For example, some people may experience two attacks of pain in a week and then nothing for a year. Others may have regular and persistent (chronic) pain.
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
Conservative treatment for Morton?s neuroma involves footwear that allows your forefoot to spread. High-heeled shoes cause neuromas by squeezing and stretching your involved intermetatarsal nerve across the ball of your foot and should be avoided as often as possible. A shoe that possesses any toe spring will also place more stress on your foot nerves and increase your likelihood of developing a neuroma. Test shoes before you buy them to see if they are appropriate for your feet. Select shoes that have a removable liner or insole, and stand on the liner, noting the position of your foot. If your foot is wider than your liner, that shoe will irritate your neuroma by squeezing your metatarsal bones together.
Surgical Treatment
If other therapies have not worked it may be necessary to perform surgery. As surgery may result in permanent numbness in the affected toe, doctors ten to use this procedure as a last resort. However, in most cases surgery is extremely effective. The patient usually receives a local anesthetic. Surgery involves either removing the nerve, or removing the pressure on the nerve. Two surgical approaches are possible. The dorsal approach, the surgeon makes an incision on the top of the foot, allowing the patient to walk soon after surgery, because the stitches are not on the weight-bearing side of the foot. The plantar approach, the surgeon makes an incision on the sole of the foot. In most cases the patient will be in crutches for about three weeks. The resulting scar may make walking uncomfortable. However, with this approach the neuroma can be reached easily and resected without cutting any structures. There is a small risk of infection around the toes after surgery.
A neuroma is an often painful enlargement of one of your body?s nerves. Morton?s neuroma is the name used to describe nerve enlargement in your foot, particularly enlargement of one of the nerves traveling to your toes in your forefoot. Morton?s neuromas most commonly develop in one of your intermetatarsal nerves, one of many nerve branches within your foot that originated in your spine. Morton?s neuroma is more likely to affect women than men.
Causes
The exact cause is unknown. Doctors believe the following may play a role in the development of this condition. Wearing tight shoes and high heels. Abnormal positioning of toes. Flat feet. Forefoot problems, including bunions and hammer toes. High foot arches. Morton neuroma is more common in women than in men.
Symptoms
People with Morton's neuroma usually complain of pain that can start in the ball of the foot and shoot into the affected toes. However, some people just have toe pain. There may also be burning and tingling of the toes. The symptoms are usually felt up the sides of the space between two toes. For example, if the nerve between the third and fourth long bones (metatarsals) of the right foot is affected, the symptoms will usually be felt up the right-hand side of the fourth toe and up the left-hand side of the third toe. Some people describe the pain that they feel as being like walking on a stone or a marble. Symptoms can be made worse if you wear high-heeled shoes. The pain is relieved by taking your shoe off, resting your foot and massaging the area. You may also experience some numbness between the affected toes. Your affected toes may also appear to be spread apart, which doctors refer to as the 'V sign'. The symptoms can vary and may come and go over a number of years. For example, some people may experience two attacks of pain in a week and then nothing for a year. Others may have regular and persistent (chronic) pain.
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
Conservative treatment for Morton?s neuroma involves footwear that allows your forefoot to spread. High-heeled shoes cause neuromas by squeezing and stretching your involved intermetatarsal nerve across the ball of your foot and should be avoided as often as possible. A shoe that possesses any toe spring will also place more stress on your foot nerves and increase your likelihood of developing a neuroma. Test shoes before you buy them to see if they are appropriate for your feet. Select shoes that have a removable liner or insole, and stand on the liner, noting the position of your foot. If your foot is wider than your liner, that shoe will irritate your neuroma by squeezing your metatarsal bones together.
Surgical Treatment
If other therapies have not worked it may be necessary to perform surgery. As surgery may result in permanent numbness in the affected toe, doctors ten to use this procedure as a last resort. However, in most cases surgery is extremely effective. The patient usually receives a local anesthetic. Surgery involves either removing the nerve, or removing the pressure on the nerve. Two surgical approaches are possible. The dorsal approach, the surgeon makes an incision on the top of the foot, allowing the patient to walk soon after surgery, because the stitches are not on the weight-bearing side of the foot. The plantar approach, the surgeon makes an incision on the sole of the foot. In most cases the patient will be in crutches for about three weeks. The resulting scar may make walking uncomfortable. However, with this approach the neuroma can be reached easily and resected without cutting any structures. There is a small risk of infection around the toes after surgery.