Morton’s neuroma is a painful and uncomfortable condition wherein the ball of the foot becomes inflamed and it feels as if you are standing on a stone in your shoe. Also called metatarsalgia or interdigital neuroma, this is a very painful condition that affects the nerves between the toes.
In Morton’s neuroma, the nerve in the foot becomes thickened, inflamed and irritated, leading to excruciating pain. Sometimes, the pain is described as burning and sharp where the toes may feel a stinging sensation and there is remarked numbness.
The most common cause of Morton’s neuroma is the prolonged use of high-heeled shoes. Many individuals had felt relief from the pain when they used low-heeled and more comfortable footwear.
The condition can occur at any age but mostly, it affects women who are middle-aged.
This is because at this age wherein they are working as professionals, they use high-heeled shoes and tight shoes. This type of footwear can place a great deal of pressure on the feet. It’s also common among runners due to the increased pressure put on the toes while running.
Morton’s neuroma is caused by the impediment and irritation of the nerve called the digital plantar nerve. This nerve is responsible for providing the sensation on the interdigital space between toes. The nerve runs along the ligament of the forefoot and it runs across the bones in the same area.
When it goes under the transverse intermetatarsal ligament, found in the ball of the foot, it can be trapped and impeded, leading to irritation. The condition is quite common among women than men, who are between the ages of 50 and 60 years old.
Generally, there is no palpable or visible sign of the condition. However, here are the common signs and symptoms of Morton’s neuroma:
- Burning pain felt in the ball of the foot and may radiate or go to the toes
- A feeling as if you’re standing on a stone or pebble inside the shoe
- Numbness and tingling sensation in the toes
At first, the patient may feel a tingling sensation or numbness in the space between the toes that gets worse as time passes by. The sensation and pain develop into a sharp shooting or burning pain at the base of the toes and the ball of the foot.
The pain worsens when the patient walks or wears shoes that are too tight. Some individuals describe walking as if there’s a small stone in the shoe, under the foot.
For runners, they may feel the pain when they push off from the start of the race. For people with high-heeled shoes, they may experience worse pain when wearing the shoe or donning ill-fitting footwear.
The risk factors of Morton’s neuroma include:
High heels – Women who wear high-heeled shoes that are ill-fitting can put pressure and impact on the toes and feet, leading to various foot problems.
Some kinds of sports – People who engage in high-impact sports like running or jogging are at a heightened risk of having Morton’s neuroma. Other sports include snow skiing and rock climbing since you’re required to use tight footwear.
Care should be taken in Morton’s neuroma diagnosis. Sometimes, it is important to go to an experienced doctor who can diagnose the condition properly. In some cases, the pathology of the nerves of the foot can be missed because the doctor may mistakenly diagnose the condition as Morton’s neuroma. It is important to take note that other serious conditions should be ruled out first.
For those with Morton’s neuroma, they have varying experiences when it comes to the pain felt. For some individuals, they feel as if they’re walking on a folded part of the sock or having a small stone stuck in the shoes. On the other hand, other people may experience numbness, cramping, and burning sensations. Also, the pain can radiate to the other parts of the feet, particularly the toes. The patients may also find it hard to walk barefoot on a hard surface.
The condition can be diagnosed through a medical history interview and a complete physical examination. During the physical assessment, the doctor may palpate a mass or a “click” in the bones. The doctor will press in the foot to feel for a tender spot.
Other tests include a range of motions tests to detect arthritis, joint swelling and other conditions of the foot and an X-ray to rule out the presence of a stress fracture.
Imaging tests – Imaging tests are used to visualize the affected area and to rule out other causes of pain like stress fractures, gout or plantar fasciitis.
X-ray – The doctor will recommend having X-rays of the foot to detect other causes of pain like stress fractures.
Ultrasound – Ultrasound uses sound waves to create photos of the affected area. It can be a good at showing abnormalities of the soft tissues like neuromas.
Magnetic Resonance Imaging (MRI) – MRI uses radio waves and a magnetic field to create 3D images of the internal tissues and organs. This is quite pricey but can detect neuromas in some people who do not have symptoms.
The treatment for Morton’s neuroma will mainly depend on the duration of the condition and its severity. The doctor can recommend simple non-surgical treatments while others may need surgery.
Initially, the doctor may recommend changing the footwear and shifting to wide-toe shoes that can help ease the pressure on the nerve. Also, he may recommend the use of orthotic devices. These are a soft pad that can be placed on the ball of the foot to relieve pressure on the affected nerve.
Pain medications – For pain relief, the doctor may recommend taking non-steroidal anti-inflammatory drugs like ibuprofen or naproxen sodium.
Injections – Injections of steroid are helpful in relieving pain and inflammation in the affected area.
Weight loss – For obese and overweight individuals, losing weight is an option to relieve pressure on the nerve.
Massage and rest – Massaging the toes and resting the foot may aid in pain relief.
Cold compress- Some individuals experience pain relief when applying ice packs on the affected area.
Cryosurgery – Cryotherapy or cryosurgery is a procedure wherein a tiny probe will be inserted into the foot and freeze the thickened nerve to destroy it.
Surgery – Surgery for Morton’s neuroma is usually recommended for people with severe pain or if all other treatment options were unsuccessful. In this case, the doctor can discuss with you the type of surgery that is best suited for you and your condition.
In surgery, the doctor will make a small incision on the top or bottom of the foot.
The nerve is accessed and he will perform two possible things – remove the part of the nerve between the toes or make it permanently numb, or increase the space of the nerve and around it, or remove some tissues.
Post surgery, the patient may need to wear a special device or protective shoe until the wound has healed. The recovery period will usually take weeks or months. However, all types of surgeries can have accompanying complications like pain, swelling, and infection.
Change in footwear – For women avoid high-heeled shoes or those with tight edges.
The toes and the nerve are impeded and this may lead to the development of Morton’s neuroma. Wearing comfortable shoes may help spread out the toes and decrease the pressure on the nerve.
Orthoses – The doctor can recommend the use of custom-fit inserts to relieve pain and irritation. These work by lifting and separating the bones.
The outlook and prognosis for Morton’s neuroma rely on the foot structure and if the treatments are successful. Some of the conservative treatments for Morton’s neuroma include cortisone injection, taking a break or having rest from activities and wearing recommended and optimal footwear.
New treatment approaches
These are non-surgical procedures used to treat Morton’s neuroma.
Ultrasound Guided Radio Frequency Ablation
Ultrasound-guided radiofrequency ablation is a modern, minimally-invasive procedure linked with success rates. It uses high-frequency radio waves to heat the nerve that is affected. It then breaks down proteins, barring the nerve fibers from transmitting pain to the brain.
Cryotherapy Ablation or ultrasound-guided cryosurgery is almost the same with radiofrequency ablation since it also causes damage to the nerves to interrupt the pain transmission. However, this procedure uses ice or cold temperatures to do the work, instead of heat.
Neurolytic injections are composed of a local anesthetic component and a sclerosing agent to reduce the ability of the nerve to transmit signals of pain in the affected area.
These procedures are new in the market and their efficacy is still being established. However, all these procedures aim to reduce the ability of the affected nerve to transmit pain signals. Hence, the affected person would not feel much