PhytoScience - Article

Morton's Neuroma

 

If you sometimes feel that you are "walking on a marble," and you have persistent pain in the ball of your foot, you may have a condition called Morton's neuroma

What is Neuroma

A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton's neuroma, which occurs at the base of the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma. "Intermetatarsal" describes its location - in the ball of the foot between the metatarsal bones (the bones extending from the toes to the midfoot). Neuromas may also occur in other locations in the foot.

The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression triggers inflammation and creates swelling of the nerve, eventually leading to permanent nerve damage.

Symptoms of a Morton's Neuroma


If you have a Morton''s neuroma, you will probably have one or more of these symptoms where the nerve damage in occurring:

  • Tingling, burning, or numbness Pain
  • A feeling that something is inside the ball of the foot, or that there's a rise in the shoe or a sock is bunched up.

The progression of a Morton's neuroma often follows this pattern:

  • The symptoms begin gradually. At first they occur only occasionally, when wearing narrow-toed shoes or performing certain aggravating activities.
  • The symptoms may go away temporarily by massaging the foot or by avoiding aggravating shoes or activities.
  • Over time the symptoms progressively worsen and may persist for several days or weeks.
  • The symptoms become more intense as the neuroma enlarges and the temporary changes
    in the nerve become permanent.

Causes


Doctors don't understand exactly what causes Morton's neuroma. The condition seems to occur in response to irritation, pressure or injury to one of the digital nerves that lead to your toes. The growth of thickened nerve tissue (neuroma) is part of your body's response to the irritation or injury.
Factors that appear to contribute to Morton's neuroma include:

  • Wearing high-heeled shoes or shoes that are tight or ill-fitting, including those that box in your feet and place pressure on your toes
  • High-impact athletic activities, such as jogging, that may subject your feet to repetitive trauma
  • Injury to your foot

In some cases, Morton's neuroma may result from abnormal movement of your foot, caused by bunions, hammertoes, flatfeet or excessive flexibility. In some cases, there's no clear cause of pressure or irritation

 

When to seek medical advice


It's best not to ignore any foot pain that lasts longer than a few days. If you experience a burning pain in the ball of your foot that's not improving, despite changing your footwear and modifying activities that may cause stress to your foot, see your doctor. He or she can examine your foot and determine whether Morton's neuroma or some other condition may be causing your pain. Early diagnosis and treatment can prevent the need for surgery.


Screening and diagnosis


Your doctor will ask about your symptoms and examine your foot. Because there's typically no outward sign of Morton's neuroma, your doctor will try to find a palpable, tender mass. There may also be a feeling of "clicking" between the bones of your foot. Your doctor may order an X-ray of your foot to rule out other foot problems.

Treatment


Treatment depends on the severity of your symptoms. Your doctor will likely recommend trying conservative approaches first. This may include resting your foot, changing to better-fitting shoes and taking over-the-counter medications to reduce inflammation and relieve pain.
If your pain is severe or persistent, or conservative approaches aren't working, you may need:

  • Corticosteroid injections. Steroids are medications that reduce inflammation. An injection of a corticosteroid medication in the area of the neuroma may reduce pain. However, overuse of injected steroids can lead to a number of side effects, including weight gain and high blood pressure, so people usually receive only a limited number of injections.

  • Surgery. Surgical removal of the growth may be necessary if other treatments fail to provide pain relief. Although surgery is usually highly successful, doctors often turn to surgery as a last resort, because the procedure removes both the neuroma and the nerve, which can leave permanent numbness in the affected toes.

Self-care


To help relieve the pain associated with Morton's neuroma and allow the nerve to heal, consider the following self-care steps:

  • Take anti-inflammatory medications. Over-the-counter nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (Advil, Motrin, others), can reduce swelling and relieve pain.

  • Try ice massage. Regular ice massage may help reduce pain. Freeze a water-filled paper cup or plastic foam cup and roll it over the painful site three times a day.

  • Change your footwear. Avoid high heels or tight shoes. Choose shoes with a broad toe box and extra depth.

  • Wear supports or pads (orthotic devices). Arch supports and foot pads fit inside your shoe and help reduce pressure on the nerve. Your doctor may prescribe a custom-made, individually designed shoe insert, which is molded to fit the contours of your foot. Or your doctor may recommend an over-the-counter metatarsal pad or bar, which you can position over the neuroma to relieve stress on the affected nerve.

  • Take a break. For a few weeks, reduce activities such as jogging, aerobic exercise or dancing that subject your feet to high impact.