Morton?s neuroma is inflammation, thickening, or enlargement of the nerve between the bones of the toes (metatarsal bones). The condition is also called intermetatarsal neuroma. The thickening is usually found between bones of the third and fourth toes of the foot, but sometimes it may develop between the second and third toes. It occurs when the medial plantar nerve near the bones of those toes becomes compressed or irritated, possibly because the metatarsal bones press against the nerve in the narrow gap between the toes. If left untreated, Morton?s neuroma can cause a sharp, burning, or shooting pain that often gets worse over time. The pain becomes worse when a person walks or stands on the ball of the foot. Sometimes the pain reaches the toes next to the neuroma and a sensation of tingling or numbness is felt.
Some experts believe that other foot conditions may also be associated with Morton’s neuroma. This is because other conditions may cause the metatarsal bones to rub against the nerve in your foot. Foot problems that may increase your risk of developing Morton’s neuroma include abnormally positioned toes, high arches, where the arch or instep of your foot is raised more than normal, flat feet, low arches or no arches at all, bunions a bony swelling at the base of the toe. Hammer toe, where the toe is bent at the middle joint. Being active and playing sport can make the painful symptoms of Morton’s neuroma worse. In particular, running or sports that involve running, such as racquet sports, can place extra pressure on the nerve in your foot, which can aggravate the problem.
It usually occurs in between the 3rd and 4th toes (about 65% of cases) as is pictured to the right. It is less commonly found in the 2nd webspace, and rarely at all in the 1st or 4th webspaces. You can also experience pins and needles and/or numbness as a result of the nerve being affected. The condition tends to occur predominantly in middle aged females.
Plain x-rays of the foot may demonstrate that one or more of the metatarsals are long (Figure #5). Not uncommonly, the second and/or third metatarsal may be long relative to the third or fourth. This can create a situation where excessive load is occurring in and around the vicinity of the interdigital nerve.
Non Surgical Treatment
Treaments may include wearing wider shoes to reduce the squeezing force on the foot. Adding a specially made padding to shoes to offload the pressure on the ball of the foot (called a metatarsal dome) Addressing the foot and lower limb biomechanics. This involves looking at foot stability and if needed prescribing an orthotic device to correct your foot position. Anesthetic & Cortisone injections. This is done when the above treatments are insufficient. The trauma is sometimes so great that conservative treatment cannot control the inflammation or cause of the pain. A series of injections are performed to control the inflammation or to temporarily settle the nerve. An ultrasound and cortisone injection can be prescribed by your podiatrist.
For severe or persistent pain, you may need surgery to remove the neuroma. Once the nerve is gone, you permanently lose feeling in the affected area. One alternative to surgery is to undergo neurolysis injections. These use chemical agents to block pain signals. Another alternative is to take a prescription pain reliever that alleviates nerve pain.
Although the exact causes of neuromas are not completely known, the following preventive steps may help. Make sure your exercise shoes have enough room in the front part of the shoe and that your toes are not excessively compressed. Wear shoes with adequate padding in the ball of the foot. Avoid prolonged time in shoes with a narrow toe box or excessive heel height (greater than two inches).