Morton’s Neuroma is a common foot condition affecting the nerves between the toes, causing discomfort and pain. It involves a thickening of nerve tissue, which can make walking and daily activities challenging. This article explores the nature of Morton’s Neuroma, how it is identified, and the various approaches available to manage it.
What is Morton’s Neuroma?
Morton’s Neuroma is a benign thickening of the tissue surrounding a digital nerve in the foot. It most frequently develops between the third and fourth toes, but can also occur between the second and third. Symptoms often include a sensation like walking on a pebble or bunched-up sock, accompanied by burning pain, numbness, or tingling in the affected toes. These typically appear in the ball of the foot and can worsen with activity or certain footwear.
It is linked to compression and irritation of the nerve. Factors contributing to its development include wearing tight, narrow, or high-heeled shoes, which force the toes into an unnatural position and increase nerve pressure. Repetitive stress from activities like running or certain foot deformities, such as bunions, hammertoes, flat feet, or high arches, can also increase the risk. This irritation causes the nerve to thicken, leading to characteristic pain and discomfort.
How Morton’s Neuroma is Diagnosed
Diagnosis typically begins with an evaluation of a patient’s symptoms and medical history. A healthcare professional will inquire about the pain’s type, location, duration, and activities that worsen or alleviate it. During the physical examination, specific maneuvers pinpoint the source of pain.
Mulder’s click is a common diagnostic test, where squeezing the foot reproduces a clicking sensation or pain, indicating a neuroma. Pressure applied to the affected area between the toes can also elicit pain. Imaging techniques, such as X-rays, rule out other foot pain causes like stress fractures. Ultrasound and MRI scans visualize thickened nerve tissue to confirm the diagnosis.
Approaches to Treatment
Treatment typically begins with conservative, non-surgical methods to reduce nerve compression and inflammation. Simple changes like wearing shoes with wider toe boxes and lower heels can alleviate nerve pressure. Custom orthotics or metatarsal pads, designed to redistribute forefoot pressure, also provide relief. Over-the-counter anti-inflammatory medications may help manage pain and swelling.
Injections are another common non-surgical approach. Corticosteroid injections deliver anti-inflammatory medication directly to the affected nerve, providing pain relief for many patients, with success rates around 50%. Alcohol injections, also known as sclerosing injections, aim to chemically ablate or weaken the nerve, with reported success rates ranging from 70% to 80%. Physical therapy, including massage and exercises, can help mobilize the toes and strengthen foot muscles, reducing nerve irritation.
When conservative treatments do not provide sufficient relief, surgical intervention may be considered. Neurectomy involves removing the affected nerve portion, often resulting in permanent numbness in the area. Another surgical option is nerve decompression, where tissues around the nerve, such as the deep transverse metatarsal ligament, are released to alleviate pressure without removal. Surgical success rates vary, with neurectomy showing high satisfaction rates, often between 80% to 95%. The goal is pain elimination, allowing individuals to resume normal activities.
What to Expect After Treatment
Recovery and long-term outlook after treatment depend on the chosen approach. For conservative treatments, relief can be gradual, requiring consistent adherence to footwear modifications and other therapies for sustained improvement. Corticosteroid injections may provide pain relief for several months, while alcohol injections can offer more lasting results. Wearing appropriate footwear is essential to prevent symptom recurrence.
Following surgical intervention, initial recovery involves managing mild to moderate pain and swelling, which can persist for several weeks or months. Patients are typically able to bear weight in a special surgical shoe shortly after the procedure. Full recovery, allowing a return to most activities and sports, can take three to six months. While surgical success rates are high, ranging from 70% to 90%, some individuals may experience persistent mild swelling or permanent numbness in the affected toes due to nerve removal. Symptom recurrence, though less common after successful surgery, can occur due to the formation of a stump neuroma.