Morton’s neuroma is a condition affecting a nerve in the foot, causing discomfort and pain. It involves the inflammation and thickening of nerve tissue, most commonly between the third and fourth toes. This condition is a benign enlargement of existing nerve tissue, not a tumor.
Understanding Morton’s Neuroma
Morton’s neuroma develops when a nerve in the ball of the foot becomes irritated and swells. This irritation often stems from compression or repeated pressure on the nerve, which can lead to its thickening and inflammation. While most frequently observed in the nerve running between the third and fourth toes, it can also affect other interdigital nerves.
Common symptoms include a burning sensation, sharp pain in the ball of the foot, or a feeling akin to stepping on a marble or a bunched-up sock. Tingling or numbness in the affected toes may also occur. Pain often intensifies with activity, especially when wearing tight or high-heeled shoes, and may temporarily subside when footwear is removed. Diagnosis typically involves a physical examination, where a doctor may press between the toes to check for tenderness or reproduce symptoms. Imaging techniques like ultrasound or MRI can also be used to confirm the diagnosis and rule out other foot conditions.
Conservative Treatment Options
Conservative, non-surgical approaches often provide relief for Morton’s neuroma. One primary modification involves footwear changes, specifically opting for shoes with a wide toe box to reduce pressure on the nerve. Avoiding high heels and tight, pointed shoes is important, as these can compress the forefoot and aggravate symptoms.
Supportive shoe inserts, known as orthotics, can be beneficial. These can be over-the-counter metatarsal pads or custom-made devices designed to redistribute pressure away from the affected nerve and provide proper arch support. Activity modification includes reducing high-impact activities like running or racquet sports and limiting prolonged standing, as these can exacerbate pain. Applying ice to the affected area and taking over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation.
Physical therapy offers exercises that strengthen foot muscles and improve flexibility, which can alleviate pressure on the nerve. For persistent pain, injections may be considered. Corticosteroid injections deliver anti-inflammatory medication directly to the nerve to reduce swelling. Alcohol sclerosing injections, administered over a series of sessions, aim to chemically destroy or shrink the nerve tissue to alleviate pain. These conservative measures are often the first line of treatment.
Surgical Interventions
When conservative treatments do not provide adequate relief, surgical options may be considered for Morton’s neuroma. Surgery is typically reserved for cases where pain remains severe and significantly impacts daily life despite non-surgical efforts. The two main surgical procedures are neurectomy and nerve decompression.
A neurectomy involves the removal of the affected portion of the nerve. This procedure excises the thickened nerve tissue. A potential outcome of a neurectomy is permanent numbness in the area supplied by the removed nerve. Nerve decompression, also known as neurolysis, focuses on releasing pressure on the nerve without removing it. This procedure often involves cutting the deep transverse metatarsal ligament, which can compress the nerve. This creates more space around the nerve, allowing it to function without irritation. While decompression aims to preserve nerve function, risks include creating scar tissue or potential long-term foot instability.
Living with and Preventing Recurrence
After treatment for Morton’s neuroma, managing recovery and preventing recurrence are important for long-term comfort. Following conservative treatments, continued adherence to supportive footwear is crucial.
This includes consistently wearing shoes with a wide toe box and low heels, along with orthotic inserts if recommended, to maintain proper foot mechanics and reduce nerve compression.
After surgical intervention, recovery times vary, but patients typically experience initial pain for a few days, followed by gradual improvement. Depending on the procedure, weight-bearing restrictions may be in place for a period, and a surgical shoe or boot might be worn to protect the foot.
Physical therapy exercises can aid in restoring strength and flexibility to the foot. To prevent recurrence, individuals should continue to avoid activities that place excessive pressure on the forefoot and remain mindful of their footwear choices. Regular self-massage and applying ice can also help manage any lingering discomfort or prevent flare-ups.