Coping with Mortons Neuroma
Overview
Morton's metatarsalgia is a condition associated with a painful neuroma* on the digital nerve causing pain in the foot. Charcterised by perineural fibrosis and nerve degeneration due to repetitive irritation, is thought to be due to irritation of the digital nerve caused by repeated trauma, ischemia or entrapment of the nerve, occurs most frequently in women aged 40-50 who wear high-heeled, pointed-toe shoes. The neuroma occurs at the level of the metatarsal necks. The common digital nerve to the third/fourth metatarsal spaces is most often affected, although other interspaces can be involved.
Causes
Various factors have been implicated in the precipitation of Morton's neuroma. Morton's neuroma is known to develop as a result of chronic nerve stress and irritation, particularly with excessive toe dorsiflexion. Poorly fitting and constricting shoes (ie, small toe box) or shoes with heel lifts often contribute to Morton's neuroma. Women who wear high-heeled shoes for a number of years or men who are required to wear constrictive shoe gear are at risk. A biomechanical theory of causation involves the mechanics of the foot and ankle. For instance, individuals with tight gastrocnemius-soleus muscles or who excessively pronate the foot may compensate by dorsiflexion of the metatarsals subsequently irritating of the interdigital nerve. Certain activities carry increased risk of excessive toe dorsiflexion, such as prolonged walking, running, squatting, and demi-pointe position in ballet.
Symptoms
What are the symptoms of Morton?s neuroma? A sharp or stinging pain between the toes when standing or walking. Pain in the forefoot between the toes. Swelling between the toes. Tingling (?pins and needles?) and numbness. Feeling like there is a ?bunched up sock? or a pebble or marble under the ball of the foot.
Diagnosis
In some cases your doctor will be able to feel the Morton's as a swelling in the middle of your foot. However they may also suggest an X-ray or a blood test - this is normally to rule our other causes of the pain such as arthritis. The most accurate way to diagnose Morton?s itself is with magnetic resonance imaging (MRI) or ultrasound.
Non Surgical Treatment
Anti-inflammatory drugs may be recommended to dull the pain and lessen swelling. Neuropathic pain medications such as the antionvulsants and / or antidepressants may be tried as well. Many are able to recover from this issue at home by icing the area, resting the feet, and by avoiding wearing narrow or tight shoes. If these remedies do not work to alleviate symptoms, the doctor may give special devices to separate the toes and avoid the squeezing of the nerve. Steroid injections may reduce pain and swelling. Surgery may be required if these do not help.
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 metatarsalgia is a condition associated with a painful neuroma* on the digital nerve causing pain in the foot. Charcterised by perineural fibrosis and nerve degeneration due to repetitive irritation, is thought to be due to irritation of the digital nerve caused by repeated trauma, ischemia or entrapment of the nerve, occurs most frequently in women aged 40-50 who wear high-heeled, pointed-toe shoes. The neuroma occurs at the level of the metatarsal necks. The common digital nerve to the third/fourth metatarsal spaces is most often affected, although other interspaces can be involved.Causes
Various factors have been implicated in the precipitation of Morton's neuroma. Morton's neuroma is known to develop as a result of chronic nerve stress and irritation, particularly with excessive toe dorsiflexion. Poorly fitting and constricting shoes (ie, small toe box) or shoes with heel lifts often contribute to Morton's neuroma. Women who wear high-heeled shoes for a number of years or men who are required to wear constrictive shoe gear are at risk. A biomechanical theory of causation involves the mechanics of the foot and ankle. For instance, individuals with tight gastrocnemius-soleus muscles or who excessively pronate the foot may compensate by dorsiflexion of the metatarsals subsequently irritating of the interdigital nerve. Certain activities carry increased risk of excessive toe dorsiflexion, such as prolonged walking, running, squatting, and demi-pointe position in ballet.
Symptoms
What are the symptoms of Morton?s neuroma? A sharp or stinging pain between the toes when standing or walking. Pain in the forefoot between the toes. Swelling between the toes. Tingling (?pins and needles?) and numbness. Feeling like there is a ?bunched up sock? or a pebble or marble under the ball of the foot.
Diagnosis
In some cases your doctor will be able to feel the Morton's as a swelling in the middle of your foot. However they may also suggest an X-ray or a blood test - this is normally to rule our other causes of the pain such as arthritis. The most accurate way to diagnose Morton?s itself is with magnetic resonance imaging (MRI) or ultrasound.
Non Surgical Treatment
Anti-inflammatory drugs may be recommended to dull the pain and lessen swelling. Neuropathic pain medications such as the antionvulsants and / or antidepressants may be tried as well. Many are able to recover from this issue at home by icing the area, resting the feet, and by avoiding wearing narrow or tight shoes. If these remedies do not work to alleviate symptoms, the doctor may give special devices to separate the toes and avoid the squeezing of the nerve. Steroid injections may reduce pain and swelling. Surgery may be required if these do not help.
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.
