Overview
This is a painful condition affecting a small nerve in the foot. It occurs when the five long bones that run the length of the foot get pushed together, pinching the nerve in between. This friction on the nerve causes it to thicken and inflame causing pain. The condition gets its name from an American surgeon, George Morton.
Causes
In many cases, a neuroma may develop as a result of excessive loading on the front of the foot. Sometimes, a patient?s anatomic alignment in the forefoot contributes to the overload. There may be some cases where the neuroma develops spontaneously, for no obvious reason. However, once the nerve is irritated, pressure from walking, and from the adjacent bony prominences (metatarsal heads), as well as from the intermetatarsal ligament that binds the heads together, all may contribute to persistent pain. Repetitive pressure on the nerve causes localized injury with resulting scarring and fibrosis of the nerve. This leads to symptoms in the distribution of the nerve.
Symptoms
The symptoms of a Morton's neuroma are classic in nature. The patient complains of a burning , tingling, slightly numb feeling (dysesthesias) which radiates out to the toes on either side of the interspace that is involved. For instance, a Morton's neuroma of the third interspace will result in pain between the third and fourth toes, and a neuroma in the second interspace will cause pain between the second and third toes. The symptoms are usually aggravated by wearing shoes, particularly those with high heels. Symptoms are relieved by walking in flat, wide shoes or going barefoot. Rarely will the patient experience pain when sitting or laying down.
Diagnosis
The most common condition misdiagnosed as Morton's neuroma is metatarsophalangeal (MTP) joint synovitis. When pain occurs in the third interspace, the clinician may misdiagnose the condition as Morton's neuroma instead of MTP synovitis, which may manifest very much like Morton's neuroma. MTP synovitis is distinguished from Morton's neuroma by subtle swelling around the joint, pain localized mainly within the joint, and pain with forced toe flexion. Palpation of the MTP joint is performed best with a pinching maneuver from the dorsal and plantar aspects of the joint to elicit tenderness of the joint. Other conditions often misdiagnosed as Morton's neuroma include the following. Stress fracture of the neck of the metatarsal. Rheumatoid arthritis and other systemic arthritic conditions. Hammertoe. Metatarsalgia (ie, plantar tenderness over the metatarsal head) Less common conditions that have overlapping symptoms with Morton's neuroma include the following. Neoplasms. Metatarsal head osteonecrosis. Freiburg. steochondrosis. Ganglion cysts. Intermetatarsal bursal fluid collections. True neuromas.
Non Surgical Treatment
The first step in treating Morton's Neuroma is to select proper footwear. Footwear with a high and wide toe box (toe area) is ideal for treating and relieving the pain. The next step in treatment is to use an orthotic designed with a metatarsal pad. This pad is located behind the ball-of-the-foot to unload pressure, and relieve the pain caused by the neuroma.
If problem persists, consult your foot doctor.
Surgical Treatment
The ultimate success of a Morton?s neuroma treated surgically can be variable. In cases where the underlying problem is only an irritated nerve (a true Morton?s neuroma), then surgery will probably be curative (although it may take a few months for the foot to fully heal). But in many cases, forefoot pain is more complex. There may be an irritated nerve or two causing pain, but the real problem is often excessive loading of the lesser metatarsals. The generic term for this condition is metatarsalgia. When considering surgery, identifying and addressing these problems may lead to a better end result.
Prevention
Wearing shoes that fit properly and that have plenty of room in the toe area may help prevent Morton's neuroma.
This is a painful condition affecting a small nerve in the foot. It occurs when the five long bones that run the length of the foot get pushed together, pinching the nerve in between. This friction on the nerve causes it to thicken and inflame causing pain. The condition gets its name from an American surgeon, George Morton.
Causes
In many cases, a neuroma may develop as a result of excessive loading on the front of the foot. Sometimes, a patient?s anatomic alignment in the forefoot contributes to the overload. There may be some cases where the neuroma develops spontaneously, for no obvious reason. However, once the nerve is irritated, pressure from walking, and from the adjacent bony prominences (metatarsal heads), as well as from the intermetatarsal ligament that binds the heads together, all may contribute to persistent pain. Repetitive pressure on the nerve causes localized injury with resulting scarring and fibrosis of the nerve. This leads to symptoms in the distribution of the nerve.
Symptoms
The symptoms of a Morton's neuroma are classic in nature. The patient complains of a burning , tingling, slightly numb feeling (dysesthesias) which radiates out to the toes on either side of the interspace that is involved. For instance, a Morton's neuroma of the third interspace will result in pain between the third and fourth toes, and a neuroma in the second interspace will cause pain between the second and third toes. The symptoms are usually aggravated by wearing shoes, particularly those with high heels. Symptoms are relieved by walking in flat, wide shoes or going barefoot. Rarely will the patient experience pain when sitting or laying down.
Diagnosis
The most common condition misdiagnosed as Morton's neuroma is metatarsophalangeal (MTP) joint synovitis. When pain occurs in the third interspace, the clinician may misdiagnose the condition as Morton's neuroma instead of MTP synovitis, which may manifest very much like Morton's neuroma. MTP synovitis is distinguished from Morton's neuroma by subtle swelling around the joint, pain localized mainly within the joint, and pain with forced toe flexion. Palpation of the MTP joint is performed best with a pinching maneuver from the dorsal and plantar aspects of the joint to elicit tenderness of the joint. Other conditions often misdiagnosed as Morton's neuroma include the following. Stress fracture of the neck of the metatarsal. Rheumatoid arthritis and other systemic arthritic conditions. Hammertoe. Metatarsalgia (ie, plantar tenderness over the metatarsal head) Less common conditions that have overlapping symptoms with Morton's neuroma include the following. Neoplasms. Metatarsal head osteonecrosis. Freiburg. steochondrosis. Ganglion cysts. Intermetatarsal bursal fluid collections. True neuromas.
Non Surgical Treatment
The first step in treating Morton's Neuroma is to select proper footwear. Footwear with a high and wide toe box (toe area) is ideal for treating and relieving the pain. The next step in treatment is to use an orthotic designed with a metatarsal pad. This pad is located behind the ball-of-the-foot to unload pressure, and relieve the pain caused by the neuroma.
If problem persists, consult your foot doctor.
Surgical Treatment
The ultimate success of a Morton?s neuroma treated surgically can be variable. In cases where the underlying problem is only an irritated nerve (a true Morton?s neuroma), then surgery will probably be curative (although it may take a few months for the foot to fully heal). But in many cases, forefoot pain is more complex. There may be an irritated nerve or two causing pain, but the real problem is often excessive loading of the lesser metatarsals. The generic term for this condition is metatarsalgia. When considering surgery, identifying and addressing these problems may lead to a better end result.
Prevention
Wearing shoes that fit properly and that have plenty of room in the toe area may help prevent Morton's neuroma.