Overview
Morton's neuroma is a condition that affects one of the nerves between the toes. It's also known as Morton's metatarsalgia or interdigital neuroma. In Morton's neuroma, fibrous tissue develops around the nerve, which becomes irritated and compressed. This causes severe pain on the ball of the foot and at the base of the toes. Morton's neuroma can occur on one foot or both feet. It usually affects the nerve between the third and fourth toes, but sometimes the second and third toes are affected.
Causes
There are many reasons to develop a neuroma. Improper shoe gear is probably the most likely cause. Repetitive activity and excessive pressure on the ball of the foot are common. Heredity and genetic factors may also be involved. In many cases the structure of the foot may predispose the condition. Associated conditions that may cause neuroma include: bunion, hammer toes, ligament laxity, and/or a tight calf muscle. Some patients may have thinning of the fat pad on the ball of the foot, which may result in increased pressure of the nerves. Tight pointy shoes (and high heels) without padding may induce pain in the ball of the foot. Neuroma may occur suddenly, or develop over time.
Symptoms
Patients with neuroma may develop pain on the bottom of the forefoot, most commonly under the 3rd and 4th toes, though any toe may be affected. The pain may be dull and mild or severe and sharp. The toes may feel ?numb? as times, especially the area between the 3rd and 4th toes. A classic complaint is that patients feel as if they are ?walking on a stone or pebble? and/or ?feel as if the sock is rolled up in the shoe.? Pain is often worse when walking barefoot.
Diagnosis
Morton's neuroma is usually diagnosed by your doctor listening to your symptoms and examining your foot. Sometimes your doctor can feel the 'neuroma', or an area of thickening in your foot, which may be tender. Sometimes, your doctor may suggest an ultrasound scan or MRI scan to confirm the diagnosis but this is not always necessary. Some doctors inject a local anaesthetic into the area where you are experiencing pain. If this causes temporary relief of pain, burning and tingling, it can sometimes help to confirm the diagnosis and show the doctor where the problem is.
Non Surgical Treatment
Sclerosing alcohol injections are an increasingly available treatment alternative if the above management approaches fail. Dilute alcohol (4%) is injected directly into the area of the neuroma, causing toxicity to the fibrous nerve tissue. Frequently, treatment must be performed 2-4 times, with 1-3 weeks between interventions. An 60-80% success rate has been achieved in clinical studies, equal to or exceeding the success rate for surgical neurectomy with fewer risks and less significant recovery. If done with more concentrated alcohol under ultrasound guidance, the success rate is considerably higher and fewer repeat procedures are needed. Radio Frequency Ablation is also used in the treatment of Morton's Neuroma The outcomes appear to be equally or more reliable than alcohol injections especially if the procedure is done under ultrasound guidance.
Surgical Treatment
The ultimate success of a Morton?s neuroma treated surgically is somewhat unclear. This is likely due to the idea that in most instances a ?Morton?s neuroma? is actually more than just an isolated nerve problem but rather consitutes a metatarsalgia where other structures (such a as the MTP joints) are also problematic, not just the nerve. Therefore, addressing the nerve as well as the other components of a metatarsalgia may offer a better chance of surgical success. However, like many conditions in foot and ankle, it is ideal if this condition can be managed without surgery.
Morton's neuroma is a condition that affects one of the nerves between the toes. It's also known as Morton's metatarsalgia or interdigital neuroma. In Morton's neuroma, fibrous tissue develops around the nerve, which becomes irritated and compressed. This causes severe pain on the ball of the foot and at the base of the toes. Morton's neuroma can occur on one foot or both feet. It usually affects the nerve between the third and fourth toes, but sometimes the second and third toes are affected.
Causes
There are many reasons to develop a neuroma. Improper shoe gear is probably the most likely cause. Repetitive activity and excessive pressure on the ball of the foot are common. Heredity and genetic factors may also be involved. In many cases the structure of the foot may predispose the condition. Associated conditions that may cause neuroma include: bunion, hammer toes, ligament laxity, and/or a tight calf muscle. Some patients may have thinning of the fat pad on the ball of the foot, which may result in increased pressure of the nerves. Tight pointy shoes (and high heels) without padding may induce pain in the ball of the foot. Neuroma may occur suddenly, or develop over time.
Symptoms
Patients with neuroma may develop pain on the bottom of the forefoot, most commonly under the 3rd and 4th toes, though any toe may be affected. The pain may be dull and mild or severe and sharp. The toes may feel ?numb? as times, especially the area between the 3rd and 4th toes. A classic complaint is that patients feel as if they are ?walking on a stone or pebble? and/or ?feel as if the sock is rolled up in the shoe.? Pain is often worse when walking barefoot.
Diagnosis
Morton's neuroma is usually diagnosed by your doctor listening to your symptoms and examining your foot. Sometimes your doctor can feel the 'neuroma', or an area of thickening in your foot, which may be tender. Sometimes, your doctor may suggest an ultrasound scan or MRI scan to confirm the diagnosis but this is not always necessary. Some doctors inject a local anaesthetic into the area where you are experiencing pain. If this causes temporary relief of pain, burning and tingling, it can sometimes help to confirm the diagnosis and show the doctor where the problem is.
Non Surgical Treatment
Sclerosing alcohol injections are an increasingly available treatment alternative if the above management approaches fail. Dilute alcohol (4%) is injected directly into the area of the neuroma, causing toxicity to the fibrous nerve tissue. Frequently, treatment must be performed 2-4 times, with 1-3 weeks between interventions. An 60-80% success rate has been achieved in clinical studies, equal to or exceeding the success rate for surgical neurectomy with fewer risks and less significant recovery. If done with more concentrated alcohol under ultrasound guidance, the success rate is considerably higher and fewer repeat procedures are needed. Radio Frequency Ablation is also used in the treatment of Morton's Neuroma The outcomes appear to be equally or more reliable than alcohol injections especially if the procedure is done under ultrasound guidance.
Surgical Treatment
The ultimate success of a Morton?s neuroma treated surgically is somewhat unclear. This is likely due to the idea that in most instances a ?Morton?s neuroma? is actually more than just an isolated nerve problem but rather consitutes a metatarsalgia where other structures (such a as the MTP joints) are also problematic, not just the nerve. Therefore, addressing the nerve as well as the other components of a metatarsalgia may offer a better chance of surgical success. However, like many conditions in foot and ankle, it is ideal if this condition can be managed without surgery.