Patients with Morton?s neuroma present with pain in the forefoot, particularly in the ?ball? of the foot. However, not all pain in the forefoot is a Morton?s neuroma. In fact, most chronic pain in the forefoot is NOT the result of a Morton?s neuroma, but rather is from metatarsalgia - inflammation (synovitis) of the ?toe/foot? joints. The symptoms from Morton?s neuroma are due to irritation to the small digital nerves, as they pass across the sole of the foot and into the toes. Therefore, with a true Morton?s neuroma, it is not uncommon to have nerve-type symptoms, which can include numbness or a burning sensation extending into the toes. There are several interdigital nerves in the forefoot. The most common nerve to develop into a neuroma is between the 3rd and 4th toes. With a true neuroma, the pain should be isolated to just one or two toes.
Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common causes comes from wearing shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box and overload pressure onto the forefoot. An injury or trauma to the forefoot may also lead to a neuroma. People at a higher risk of developing a Neuroma include people with certain foot deformities, such as bunions or hammertoes. Certain foot types, such as flat feet (Pronation) More flexible feet, and woman after pregnancy.
Typically, there's no outward sign of this condition, such as a lump. Instead, you may experience the following symptoms. A feeling as if you're standing on a pebble in your shoe. A burning pain in the ball of your foot that may radiate into your toes. Tingling or numbness in your toes. It's best not to ignore any foot pain that lasts longer than a few days. See your doctor 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.
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a Morton's neuroma. Investigations such as an X-ray, ultrasound, MRI, CT scan or bone scan may sometimes be used to assist with diagnosis, assess the severity of the injury and rule out other conditions.
Non Surgical Treatment
Nonsurgical treatment is tried first. Your doctor may recommend any of the following. Padding and taping the toe area, shoe inserts, changes to footwear, for example wearing shoes with wider toe boxes or flat heels, Anti-inflammatory medicines taken by mouth or injected into the toe area, nerve blocking medicines injected into the toe area, other painkillers, physical therapy. Anti-inflammatories and painkillers are not recommended for long-term treatment. In some cases, surgery is needed to remove the thickened tissue and inflammed nerve. This helps relieve pain and improve foot function. Numbness after surgery is permanent.
About one person in four will not require any surgery for Morton's neuroma and their symptoms can be controlled with footwear modification and steroid/local anaesthetic injections. Of those who choose to have surgery, about three out of four will have good results with relief of their symptoms. Recurrent or persisting (chronic) symptoms can occur after surgery. Sometimes, decompression of the nerve may have been incomplete or the nerve may just remain 'irritable'. In those who have had cutting out (resection) of the nerve (neurectomy), a recurrent or 'stump' neuroma may develop in any nerve tissue that was left behind. This can sometimes be more painful than the original condition.
To help reduce your chance of developing Morton's neuroma avoid wearing tight and/or high-heeled shoes. Maintain or achieve ideal body weight. If you play sports, wear roomy, properly fitting athletic footwear.