Introduction:
Morton’s Neuroma is a painful situation; felt at the plantar surface of foot (sole), in which one of the plantar digital nerve, passing between the long bones of the foot, is compressed or affected. A severe pain is felt at the base of the foot due to the irritation caused in the nerve.
The most common site where Morton’s Neuroma compresses or affects the nerve is between the third of forth metatarsal bones, toes. It can also affect the nerve between first and second metatarsal bones or even between second and third metatarsal bones, but most commonly it affects the nerve between third and forth metatarsal bones. Morton’s Neuroma thickens the tissues surrounding that particular nerve and results in causing severe pain.
Symptoms:
People who are suffering from Morton’s Neuroma initially feel tingling sensation between the affected metatarsals. This tingling sensation is felt due to the irritation caused in the nerve. The tingling than eventually will lead to pain. The pain, with passage of time become worst and might result in toe cramping. This pain is usually a burning pain at the base of the foot. When a person walks the pain becomes worst and he/she might feel that he/she is walking on stone or marble.
Etiology:
The etiology of Morton’s Neuroma is yet unknown, but it is thought that Morton’s Neuroma might result due to prolong standing (chronic) stress which results in compression of the plantar nerve or may be due to swelling at the base of foot, which might cause pressure, irritation and compression in the nerve. Development of bursa and growth of lipoma can also cause compression in the digital nerve of foot. Other causes can include abnormal anatomy and growth of bones can also cause nerve compression which causes Morton’s Neuroma.
Factors Leading To Morton’s Neuroma:
The most common and obvious reason of developing Morton’s Neuroma is wearing high heel shoes or shoes that are tight. The high heel shoes and shoes that are tight cause pressure on the ball of the foot which results in nerve irritation and compression. Women are more prone to Morton’s Neuroma than men.
Secondly, people who have high arches or are flatfoot are more prone to develop Morton’s Neuroma because they are more prone to nerve compression. Lastly, people who participate more in sport activities such as high jumps, running or jogging are also prone to Morton’s Neuroma because of repetitive trauma.
Diagnosis:
While examining the doctor will press the patient’s foot in order to feel a mass or click between the bones. The doctor will apply pressure between the bones of the foot and will look for evidences of stress fracture which might cause pain. Else he/she might prescribe the patient to have an x-ray, ultrasound or MRI (magnetic Resonance Imaging) to find the cause.
Treatment:
The severity of symptom lets you know what kind of treatment procedure to use. The treatment can be surgical or non-surgical.
1) Non-surgical treatment:
If the Morton’s Neuroma is diagnosed at an early stage than non-surgical method is used. Non-surgical treatment includes:
i. Adjustment of footwear: High heel shoe or tight shoes are prohibited.
ii. Stretching exercises: Calf muscles stretching exercise is to be done on daily basis to reduce the pressure on the foot.
iii. Usage of orthotic devices: orthotic devices will support foot arches and will also reduce pressure on the foot.
iv. Injections: Local anaesthetic is inserted in the affected region of the foot to relieve the symptoms.
v. Medication: Steroids, anti-inflammatory and painkillers are given to relieve the symptoms.
2) Surgical treatment:
If non-surgical methods do not work than surgery is done. In surgery an incision is made either on the plantar or dorsal surface of the foot, between the affected toes or metacarpals. The surgeon usually creates a gap around the affected nerve or he/she simply removes the affected nerve. If the nerve is permanently removed than there will be numbness in the skin between the affected toes and this will not cause any problem. The patient is asked to wear special shoes for temporary basis, until wound is completely healed and normal footwear is used again.