Morton’s Neuroma


What is it?

Morton’s neuroma is characterized by the thickening of tissue around the nerve, typically between your third and fourth toe. The thickening of this tissue causes a sharp pain in the ball of your foot. 

Morton’s neuroma is the compression and irritation of the nerve and can result in permanent nerve damage if not treated. This is a degenerative condition and is fairly common.

 

Who is affected?

Both men and women are affected by Morton’s neuroma, but it is seen more frequently in women as the development of this condition is linked to wearing high-heeled shoes. 

People who participate in high-impact sports, such as running, have a higher chance of being affected by Morton’s due to repetitive foot trauma. Any sport with tight shoes that puts pressure on your toes, like skiing, can also contribute to Morton’s neuroma.

 

What are the symptoms?

There is no apparent lump that you can see with Morton’s neuroma, but you will experience burning pain in the ball of your foot that can spread to your toes. You may also experience tingling or numbness in your toes. One of the most common ways to describe Morton’s neuroma is feeling as if you’re standing on a pebble in your shoe. 

Pain will worsen when wearing poorly fitting or high-heeled shoes. Walking will worsen your symptoms as well.

 

What causes it?

Morton’s neuroma is the response of irritation or trauma to the nerve. High heels, especially those that are tight or ill-fitting, put extra pressure on the ball of your foot and can result in a damaged nerve. 

High heels aren’t the only shoe to be wary of. If you participate in any athletic activity or sport that features tight shoes, you could be at risk for nerve damage in your feet. 

If you already suffer from a type of foot deformity, which impacts the nerves in your feet, your chances of developing Morton’s neuroma increase.  Foot deformities to be aware of include bunions, hammertoes, high arches or flatfeet. If you do suffer from any of the conditions listed, it does not mean you will develop Morton’s neuroma. 

 

How is the condition diagnosed?

During an exam, your Doctor will feel your foot for any abnormalities and tender areas. Diagnostic imaging tools can also be used to aid in diagnosis. X-rays can help rule out other possible diagnoses while ultrasound and MRI are able to reveal any soft tissue irregularities, like a neuroma.

 

What are potential treatments?

The severity of your neuroma will influence your treatment plan. Initial treatments are more conservative:

  • Rest your foot by reducing activities that put pressure on your toes
  • Change your footwear! Avoid tight, ill-filling, pointy and high-heeled shoes
  • Wear arch supports and foot pads inside your shoe
  • Take an anti-inflammatory to reduce pain and swelling
  • Ice your foot for 10-15 minutes at a time
  • Massage your foot

If you are not seeing results with a conservative treatment plan, other potential treatments include steroid injections, decompression surgery or removal of the nerve. 

Surgical intervention is only recommended after conventional treatment plans have been exhausted. It is very rarely indicated nowadays. 

Wilderman Medical Clinic offers several different types of treatments for Morton’s neuroma.

 

Ultrasound guided injections with cortisone

Cortisone injections are a popular treatment choice because it has favorable outcomes. Corticosteroids reduce swelling and reduce the associated pain. The limitations include fairly short pain relief – one to three months, requiring repeated injections.

 

Dilute alcohol injections

Dilute alcohol injections desensitize the damaged nerve and reduce the related pain. This procedure requires repeated injections. It has a fairly high success rate.

 

Prolotherapy

Prolotherapy is a regenerative injection used in musculoskeletal conditions. This procedure promotes healing and strengthening the affected area.

 

Botox injections

There has been success using Botox injections to improve pain associated with Morton’s neuroma. Patients achieve improved function and a decrease in pain when Botox is injected to the affected area.

 

Assistive devices such as TENS

Transcutaneous Electrical Nerve Stimulation (TENS) is a portable device that sends mild electrical signals to the affected area through electrodes. TENS are used to lessen pain and can be used for a few hours or up to an entire day. 

Other treatments, not available at our clinic:

RF ablation

RF ablation heats the damaged nerves with radiofrequency, interrupting the nerve signals in your feet (neurolysis). RF ablation has been suggested to be a favorable surgical substitute. 

Physiotherapy

Physiotherapy can be used to release pressure on the damaged nerve, resulting in reduced pain.

Acupuncture

Acupuncture is based on the theory of energy or “chee”. It is believed to reduce the formation of scar tissue and promote healing. 

Orthotics

Orthotics are used to increase support in your shoes and alleviate foot pain.

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