What is Morton's neuroma?
Morton's neuroma, also known as Morton’s metatarsalgia, is a benign growth of nerve tissue. It is a painful condition that affects the ball of the foot, most commonly occurring between the third and fourth toes. This thickening of the tissue around one of the nerves that supplies sensation to the adjacent toes causes pain, a burning sensation, tingling, or numbness between the toes, around the ball of the foot or at the base of your toes.
The condition is named after Thomas George Morton, an American Civil War surgeon. In 1876, Morton described a condition that occurred in fifteen patients of his own and one patient of a colleague. The patients all shared the same complaints, which Morton termed metatarsalgia, an injury to the fourth metatarsophalangeal joint.
What causes Morton's neuroma?
The exact cause of Morton's neuroma is not always clear, but it is often associated with irritation, pressure, or injury to the nerve. Factors that may contribute to its development include wearing tight or ill-fitting shoes, high heels, or engaging in activities that put repetitive stress on the forefoot.
Having pre-existing foot or gait abnormalities such as that which occur in individuals with bunions, high arches, flat feet, or hammer toes, may also lead to Morton’s neuroma due to instability and additional pressure on foot nerves.
Athletes are at risk of developing Morton's neuroma from repetitive trauma to the ball of the foot caused by running or racquet sports, as well as those who participate in activities that require tight footwear, such as skiing or ballet.
It's essential to seek medical attention if you suspect you have Morton's neuroma or are experiencing persistent foot pain in order to receive a proper diagnosis an appropriate treatment plan.
What are the symptoms of Morton's neuroma?
Symptoms often appear gradually, and pain will begin to intensify during athletic activities or while wearing narrow-toed, tight or ill-fitting shoes. As the neuroma enlarges, the symptoms will become more chronic and uncomfortable. The most common symptoms of Morton's neuroma include:
- It will feel as if you are standing on a pebble in your shoe or on a fold in your sock.
- There is a sharp, burning, or shooting pain in the ball of the foot, which may extend to the toes.
- You may experience a feeling of numbness or tingling in the affected toes.
- Symptoms worsen during activities that involve walking or wearing tight shoes.
- Pain improves with removing shoes and resting the foot.
How is it diagnosed?
To diagnose Morton's neuroma, a healthcare professional will typically perform a physical examination and review your medical history. The examination may involve applying pressure to the affected area to elicit pain or reproducing the symptoms through specific movements. Imaging studies are sometimes ordered, like X-rays to rule out other possible reasons for your symptoms such as a stress fracture or arthritis; MRI (magnetic resonance imaging), which will provide a better visual of the soft tissues in the foot, and/or an Ultrasound, which will help identify abnormalities in the soft tissue.
What are the treatment options for Morton's neuroma?
Treatment approaches depend on the development and severity of Morton's neuroma. For mild or moderate cases, a physician will recommend that you make some changes in your habits:
- Avoid high heels or tight shoes.
- Wear wider shoes with lower heels and a soft sole. This enables the bones to spread out and may reduce pressure on the nerve, giving it time to heal.
- Wear custom shoe inserts and pads to help relieve irritation by lifting and separating the bones, reducing the pressure on the nerve.
- Be sure to have adequate padding on the metatarsal arch to support and lessen the pressure on the foot nerves, decreasing compression while walking.
- Ice the afflicted area to reduce swelling and inflammation and to numb the area.
- Refrain from athletic activities until the condition improves.
- Take oral nonsteroidal, anti-inflammatory drugs (NSAIDs), such as ibuprofen, to relieve pain.
- Corticosteroid injections can be prescribed to reduce swelling and inflammation and to provide some relief.
- Specific exercises can be prescribed to help improve foot strength and flexibility.
Several studies have shown that a combination of roomier, more comfortable shoes, nonsteroidal anti-inflammatory medication, custom foot orthotics, and cortisone injections provide relief in over 80 percent of people with Morton's Neuroma.
When is surgery recommended?
In cases where conservative treatments do not provide sufficient relief, or the condition is severe, surgical intervention may be considered. The surgery involves removing the swollen nerve tissue or releasing the ligament that is pressing on the nerve.
This surgery is normally an out-patient procedure, performed under a general anesthetic, with a post-operative local anesthetic administered in the foot to minimize pain. A tiny incision is made between the toes, either to make more space around the nerve by taking away the neighboring tissue or to remove a portion of the nerve itself, which will result in the area between your toes becoming permanently numb. It is highly recommended that you stop smoking at least eight weeks before surgery because smoking affects your ability to heal and can lead to a greater risk of pulmonary embolism (blood clots forming in the lungs) or deep vein thrombosis (blood clots in the calf). Most patients are able to go home on the same day as the surgery.
What is the recovery time for Morton's neuroma surgery?
After surgery, your foot and ankle will be bandaged for two weeks. You will be instructed how to walk in a special orthopedic shoe, which protects your foot. You should rest your foot, keeping as much weight off it as possible, and keep it elevated above the level of your heart whenever you are able, especially in the first week after surgery.
Your pain levels should reduce greatly after one week and you may be able to return to work during the second week following the operation. After two to three weeks, you can return to some activities, starting with low impact exercise and gradually increasing. Most patients are able to resume their previous sporting activity around six weeks after surgery. Some slight swelling may persist for up to twelve months.
The prognosis for Morton's neuroma varies depending on the severity of the condition and how well it responds to treatment. With appropriate, timely management, many people experience significant improvement in their symptoms. However, in some cases, the pain may persist or recur despite treatment. Early intervention generally leads to better outcomes and may prevent the need for additional invasive treatments.
