Morton’s neuroma: What are the treatments?

Morton’s neuroma is a benign (non-cancerous) swelling of nerve tissue that occurs in the foot, generally between the third and fourth toes. It’s a common and painful illness that affects many people.

Morton’s metatarsalgia, Morton’s disease, Morton’s neuralgia, Morton metatarsalgia, Morton nerve entrapment, plantar neuroma, and intermetatarsal neuroma are all terms used to describe this condition.

Typically, it occurs between the bases of the third and fourth toes and results from a swollen nerve in the ball of the foot.

Important facts on Morton’s neuroma

  • Morton’s neuroma is characterized by an abnormal development of nerve tissue that is not cancerous.
  • It results in discomfort in the ball of the foot.
  • \Surgery is a viable option, but it is only utilized after all other options, such as workouts and home cures, have been tried and failed.
  • Although the specific cause of Morton’s neuroma is still unknown, wearing high heels and participating in certain activities have been shown to be associated with the condition.

Causes

Wearing high-heeled shoes
Morton’s neuroma is a condition that is often caused by wearing high-heeled shoes.

Morton’s neuroma is a condition for which experts are unsure of the specific cause. It seems to occur as a consequence of irritation, pressure, or damage to one of the nerves that supply the toes, triggering a reaction that results in thicker nerve tissue (neuroma).

Morton’s neuroma affects a large number of women who wear high-heeled or narrow shoes.

Situations and conditions that might cause the bones to rub against a nerve include, but are not limited to, the following:

  • high-heeled shoes, especially those over 5 centimeters
  • shoes with a pointed or tight toe box that squashes the toes together
  • high-arched feet
  • flat feet, when the entire sole comes into contact with the ground
  • a bunion, a localized painful swelling at the base of the big toe that enlarges the joint
  • hammer toe, a deformity within a joint of the second, third, or fourth toe that causes it to be permanently bent
  • some high-impact sporting activities, including running, soccer, tennis, karate, and basketball
  • injury or trauma to the foot

High heels and narrow-toed shoes are likely to blame for the condition’s higher prevalence in girls than in men, according to research.

Treatment

Patients suffering from Morton’s neuroma may be required to modify their footwear, take pain relievers, or get steroid injections to alleviate their symptoms. Surgical intervention may be required in certain circumstances to either remove the damaged nerve or relieve the strain on it.

Treatment is determined by a number of variables, including:

  • the severity of symptoms
  • how long they have been present
  • whether home treatment has been tried

The sooner the disorder is identified, the less probable it is that surgery will be required.

If self-help approaches don’t work and the symptoms are severe or chronic, the doctor may suggest:

  • Corticosteroid injections: A steroid medication is injected into the neuroma region to alleviate inflammation and discomfort. Because there may be negative effects, only a small number of injections are recommended. Hypertension (high blood pressure) and weight gain are examples of such conditions.
  • Alcohol sclerosing injections: Alcohol injections have been demonstrated in studies to lessen the growth of Morton’s neuromas while also reducing discomfort. Injections are given every 7 to 10 days on average. Four to seven shots are generally required for optimal relief.

Morton’s neuroma surgery

If previous treatments have failed and symptoms have persisted after 9 to 12 months, surgery may be recommended.

Although surgery is typically successful, it might cause lifelong numbness in the afflicted toes. This is why physicians advise that patients explore alternative choices first.

The nerve is either removed or the strain on the nerve is relieved by cutting surrounding ligaments or fibrous tissue.

There are two surgical methods that may be used:

  • Dorsal approach: Because the stitches are not on the weight-bearing side of the foot, the surgeon makes an incision on the top of the foot, enabling the patient to walk quickly after surgery.
  • Plantar approach: The surgeon makes an incision on the sole of the foot. Most patients will require crutches for roughly 3 weeks throughout their recovery. Walking may be difficult as a consequence of the scar. The neuroma, on the other hand, may be readily accessible and removed without causing any structural damage.

Following surgery, there is a minor risk of infection around the toes.

Symptoms

Foot pain
The most typical symptom of Morton’s neuroma is foot discomfort in the ball of the foot, which is commonly characterized as burning.

Afflicted patients report numbness and soreness in the affected area, which can be alleviated by removing their shoes and rubbing the affected foot.

Morton’s neuroma is a condition in which the tissue around one of the nerves that leads to the toes becomes thickened, resulting in an intense, burning sensation in the ball of the foot.

Morton’s neuroma manifests itself physically in the form of a lump, which is highly unusual. Morton’s neuroma signs and symptoms frequently appear suddenly and increase with time, indicating that the condition is progressive.

When the foot bears weight, the most common symptom is discomfort. A shooting sensation may occur on the sides of two toes that are next to each other. It is possible to feel it after only a brief period of walking.

It is possible to have a dull ache rather than an acute one at times. In the majority of cases, discomfort is reported between the third and fourth toes. Typically, a patient may suffer acute discomfort while walking and will be forced to stop and remove their shoe from their foot.

Other signs and symptoms include:

  • a sensation that something is inside the ball of the foot.
  • paresthesia, a tingling, pricking, or numbness with no apparent long-term physical effect, commonly known as pins-and-needles
  • numbness may affect the toes
  • burning pain, often described as like a “red hot needle,” which can start suddenly while walking

An increasing number of patients describe the sensation as a scorching pain in the ball of the foot that frequently spreads to the toes.

In the beginning, the discomfort may become much more noticeable when the individual wears tight or narrow shoes or high-heeled shoes, or when the person engages in activities that put pressure on the foot. Symptoms may be constant and linger for several days or even several weeks at a time.

Individuals suffering from severe symptoms may get worried about walking or even putting their foot on the ground for extended periods of time. Some people, however, do not have any symptoms, and MRI scans may identify Morton’s neuroma lesions in patients who do not exhibit any symptoms at all.

Exercises

Even though Morton’s neuroma responds well to rest, certain stretching and strengthening activities may be beneficial in preserving and improving arch strength in the foot provided the discomfort is manageable.

These include activities such as:

  • stretch the lower leg, calf, and achilles muscles
  • stretch the plantar fascia along the bottom of the foot

To prevent the nerve from getting irritated again, exercise should be started carefully.

Here are some easy workouts to try:

Take your heel in one hand and position the other beneath the ball of your foot and toes to stretch the plantar fascia. Pull the front of the foot and toes backwards toward the shin.

This exercise may also be done by sitting with your feet out in front of you and slowly pushing your toes back toward your shin with your palm. You may be able to bring your toes back without using your hand over time.

Roll your foot back and forth over a bottle on the floor to stretch it.

Make figure-of-eight patterns with the foot, leading with the big toe, to strengthen the foot.

Athletes may be able to return to exercise by following a regimen that progressively becomes more difficult.

On the first day, a physical therapist would recommend walking for 4 minutes and running for 2 minutes, then resting on the second day. The athlete might progressively increase the time spent on more strenuous exercise by exercising on alternate days.

A researcher claimed in 2012 that therapeutic massage provided pain alleviation to one patient.

Once a week, six massage treatment sessions were given, each lasting 60 to 75 minutes. Every day, the participant did the above-mentioned activity to stretch the plantar fascia at home. Postural alignment and leg and foot treatment were the emphasis of the massage.

The patient said that her pain had altered from searing and stabbing to dull and pulsating after three sessions.

Home treatments

The following are some self-help options for Morton’s neuroma:

  • managing or reducing bodyweight management, as this can improve symptoms in people with excess weight
  • taking over-the-counter (OTC) painkilling medications
  • resting the foot
  • modifying activities, for example, avoiding or taking a break from activities that put repetitive pressure on the neuroma, until the condition improves
  • using an ice pack, wrapped in a cloth, on the affected area
  • massaging the foot and affected toes
  • using arch supports a type of padding that supports the arch of the foot and removes pressure from the nerve
  • wearing broad-toed shoes, to allow toes to spread out and reduce friction
  • doing strength exercises, to strengthen the foot muscles

Over-the-counter orthotic devices, arch supports, metatarsal pads, and bars are all available. These can be applied directly to the neuroma.

Taking steps to lower your blood pressure will help you feel better.

Diagnosis

The patient will be asked to explain the pain, its intensity, and when the symptoms began by a doctor or a podiatrist (foot expert). They’ll also inquire about their footwear, as well as their occupation, lifestyle, and interests.

The doctor will examine the foot and try to pinpoint the nerve that is causing the problem. This may entail twisting the foot in an attempt to mimic symptoms. The doctor may also use a movement to elicit a feeling of “clicking” between the toes, which is an indication of Morton’s neuroma.

One of the following scans might be ordered to provide a detailed view of the inside of the foot:

  • Ultrasound scans – are inexpensive, do not emit radiation, and can detect Morton’s neuroma with the same precision as an MRI. It can also be used to identify Morton’s neuroma from other disorders that are similar to it, such as synovitis.
  • MRI is a more costly imaging test that can detect Morton’s neuroma even when no symptoms exist.
  • X-rays can rule out other foot injuries, such as a stress fracture.

Other conditions with identical symptoms, such as capsulitis, bursitis, or Freiberg’s disease, must be ruled out by the doctor.

Sources

  • http://journals.lww.com/orthopaedicnursing/Abstract/2002/11000/Diagnosis_and_Treatment_of_Interdigital_Perineural.8.aspx
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390214/
  • http://link.springer.com/article/10.1007/s00330-003-2057-7
  • https://www.medicalnewstoday.com/articles/179773
  • http://my.clevelandclinic.org/health/diseases_conditions/hic_mortons_neuroma
  • http://orthoinfo.aaos.org/topic.cfm?topic=a00158
  • http://www.nhs.uk/conditions/mortonsneuroma/Pages/Introduction.aspx
  • http://www.sportsinjuryclinic.net/sport-injuries/foot-heel-pain/mortons-neuroma
  • http://surgicaltechniques.jbjs.org/content/2/3/e14