Dealing With Mortons NeuromaOverview
Interdigital neuroma (Morton?s Neuroma) of the foot includes common, paroxysmal, neuralgia affecting the web spaces of the toes. It involves entrapment neuropathy (nerve compression) of the common digital nerve below and between the metatarsal heads, typically between the third and the fourth metatarsal heads. The pain is most commonly felt between the third and fourth toes but can also occur in the area between the second and third toes.
The exact cause of Morton's neuroma is not known. However, it is thought to develop as a result of long-standing (chronic) stress and irritation of a plantar digital nerve. There are a number of things that are thought to contribute to this. Some thickening (fibrosis) and swelling may then develop around a part of the nerve. This can look like a neuroma and can lead to compression of the nerve. Sometimes, other problems can contribute to the compression of the nerve. These include the growth of a fatty lump (called a lipoma) and also the formation of a fluid-filled sac that can form around a joint (a bursa). Also, inflammation in the joints in the foot next to one of the digital nerves can sometimes cause irritation of the nerve and lead to the symptoms of Morton's neuroma.
Symptoms typically include pain, often with pins and needles on one side of a toe and the adjacent side of the next toe. Pain is made worse by forefoot weight bearing and can also be reproduced by squeezing the forefoot to further compress the nerve. Pressing in between the third and forth metatarsals for example with a pen can also trigger symptoms.
Based on the physical examination, your doctor usually can diagnose a Morton's neuroma without additional testing. A foot X-ray may be ordered to make sure that there isn't a stress fracture, but it will not show the actual neuroma. If the diagnosis is in doubt, your doctor may request magnetic resonance imaging (MRI) of the foot.
Non Surgical Treatment
Conservative treatment involves a reduction in the inflammation and removing the impingement factor. Reduction in inflammation is achieved via rest, elevation, ice, and massage with anti-inflammatory gels. Removing foot wear and and/r wearing broad type footwear would also help. Injection therapy is useful in reducing symptoms but not very successful in providing long term relief. The only time when it is most appropriate is when the cause of the space occupying object is not a neuroma but an inflamed bursa. Injection would help to relieve symptoms, and often cortisone is not even necessary.
If these non-surgical measures do not work, surgery is sometimes needed. Surgery normally involves a small incision (cut) being made on either the top, or the sole, of the foot between the affected toes. Usually, the surgeon will then either create more space around the affected nerve (known as nerve decompression) or will cut out (resect) the affected nerve. If the nerve is resected, there will be some permanent numbness of the skin between the affected toes. This does not usually cause any problems. You will usually have to wear a special shoe for a short time after surgery until the wound has healed and normal footwear can be used again. Surgery is usually successful. However, as with any surgical operation, there is a risk of complications. For example, after this operation a small number of people can develop a wound infection. Another complication may be long-term thickening of the skin (callus formation) on the sole of the foot (known as plantar keratosis). This may require treatment by a specialist in care of the feet (chiropody).