Morton's Neuroma: Everything You Need to Know

Morton's Neuroma

 Overview

Morton's neuroma affects the ball of the foot and is a benign yet painful ailment. It's also known as an intermetatarsal neuroma because it's found between your metatarsal bones in the ball of your foot.

It occurs when the tissue around a nerve leading to the toe thickens as a result of irritation or compression. It usually happens between the third and fourth toes, but it can also happen between the second and third. It mostly affects people in their forties and fifties, especially women in their forties and fifties.

What are the signs and symptoms?

Morton's neuroma is characterized by pain that is typically intermittent. It may feel like you're standing on a marble or pebble in your shoe or a bunched-up sock, or it may feel like a burning agony in your ball or foot.

As the pain spreads, your toes may become numb or tingly. Because of the pain, you may find it difficult to walk normally. However, there will be no visible swelling on your foot.

Morton's neuroma can occur without causing any symptoms. In a short study published in 2000, researchers looked at the medical records of 85 persons who had their feet MRI'd (MRI). Morton's neuroma was discovered in 33% of the subjects, however there was no pain.

Morton's neuroma is caused by a variety of factors.

Shoes that are overly tight or have high heels are frequently the cause of Morton's neuroma. The nerves in your feet may become crushed or irritated as a result of wearing these shoes. As a result of the strain on the irritated nerve, it thickens and becomes increasingly painful.

A foot or gait anomaly is another possible reason, which can cause instability and put pressure on a nerve in your foot.

Morton's neuroma is frequently linked to:

High arches, bunions, and hammer toes are all symptoms of flat feet.

It's also linked to a variety of activities, including:

repeated sports activities that increase pressure on the ball of the foot, such as running or racquet sports, sports that need tight shoes, such as skiing or ballet

A neuroma can develop as a result of a foot injury.

When should you consult a physician?

Consult your doctor if your foot discomfort persists despite changing your footwear or ceasing any activity that may be causing it. Morton's neuroma is curable, although it can cause lasting nerve damage if not treated soon.

Your doctor will ask you about the onset of the discomfort and inspect your foot. They'll apply pressure to the ball of your foot and move your toes to determine where the pain is coming from. A physical examination and discussion of your symptoms will typically be enough for a doctor to diagnose Morton's neuroma.

Your doctor may request imaging tests to rule out other possible reasons of your discomfort, such as arthritis or a stress fracture. These can include the following:

X-rays are used to rule out the possibility of arthritis or fractures.

Ultrasound scans are used to detect soft tissue abnormalities, while an MRI is used to detect soft tissue abnormalities.

An electromyography may be performed if your doctor detects another nerve issue. This test measures the electrical activity produced by your muscles, which can help your doctor better understand how well your nerves are functioning.

What is the treatment for Morton's neuroma?

The severity of your symptoms will determine how you are treated. A progressive plan is frequently used by your doctor. That means you'll start with cautious measures and then progress to more severe measures if your pain persists.

Treatments that are conservative and done at home

The use of arch supports or foot pads in your shoes is a good place to start with conservative treatment. These aid in relieving pressure on the nerve in question. They can be over-the-counter (OTC) inserts or custom-made to fit your foot with a prescription. OTC pain relievers or nonsteroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen (Advil, Motrin) or aspirin may also be recommended by your doctor.

Treatments that are more conservative include:

Stretching exercises for tendons and ligaments in physical therapy

resting your foot and administering ice to uncomfortable regions massage the ball of your foot exercises to strengthen your ankles and toes

Injections

If your pain persists, your doctor may prescribe corticosteroids or anti-inflammatory medicines to be injected into the painful location. To numb the afflicted nerve, a local anesthetic injection may be utilized. This may provide temporary relief from your pain.

Another treatment option is alcohol sclerosing injections, which may provide temporary pain relief. However, only 29% of those who had alcohol injections remained symptom-free after a long period of time, according to a long-term research.

Surgery

Your doctor may recommend surgery if previous therapies have failed to provide relief. There are a variety of surgical options available, including:

cryogenic surgery, also known as cryogenic neuroablation, is a procedure in which nerves and the myelin sheath that surrounds them are killed using extremely cold temperatures.

Cutting ligaments and other tissues around the nerve to relieve pressure on the nerve is known as decompression surgery.

What can you anticipate?

The length of your recovery will be determined on the severity of your Morton's neuroma and the treatment you receive. A switch to bigger shoes or shoe inserts can provide immediate comfort for some people. Others may need injections and medicines to achieve long-term relief.

The length of time it takes to recuperate from surgery varies. Nerve decompression surgery has a rapid recovery time. Following surgery, you will be able to bear weight on the foot and wear a padded shoe.

A neurectomy takes longer to recover from, taking anywhere from one to six weeks depending on where the surgical cut is done. If your incision is towards the bottom of your foot, you may need to use crutches for three weeks and recover more slowly. If your incision is on the top of your foot, you can immediately put weight on it while wearing a special boot.

In both circumstances, you'll need to minimize your activities and sit as often as possible with your foot elevated above your heart level. Until the incision heals, you'll also need to keep the foot dry. In 10 to 14 days, your doctor will change the surgical dressing. Your ability to return to work depends on how much of your employment requires you to be on your feet.

What is the prognosis?

Morton's neuroma patients benefit 80 percent of the time from conservative treatment. Although there are few long-term studies of surgical treatment outcomes, the Cleveland Clinic states that in 75 to 85 percent of instances, surgery effectively relieves or lowers symptoms.

There are few statistics that compare the outcomes of different treatments. According to a short 2011 study, 41% of people who changed their footwear needed no additional therapy. 47 percent of those who had injections improved and didn't require further treatment. 96 percent of those who needed surgery improved.

What can you do to keep it from happening again?

Wearing the correct shoes is one of the simplest strategies to avoid Morton's neuroma recurrence.

• For long periods of time, avoid wearing tight shoes or shoes with high heels.

• Choose shoes with a big toe box and lots of area for your toes to flex.

• Wear an orthotic insert if your doctor prescribes it to relieve pressure on the ball of your foot.

• If you stand or walk a lot, consider wearing padded socks to protect your feet.

• Wear padded athletic footwear to safeguard your feet if you participate in sports.

• Get an antifatigue mat if you spend a lot of time standing in the kitchen, at the cash register, or at a standing workstation. These cushioned mats might help your feet feel better.

You might also wish to consult a physical therapist for a stretching and strengthening routine for your legs and ankles.