Archive for June 2017

Working with Mortons Neuroma

Overview

Morton’s neuroma (also known as Morton neuroma, Morton’s metatarsalgia, Morton’s neuralgia, plantar neuroma, intermetatarsal neuroma, and interdigital neuroma) is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the second and third intermetatarsal spaces (between 2nd-3rd and 3rd-4th metatarsal heads), which results in the entrapment of the affected nerve. The main symptoms are pain and/or numbness, sometimes relieved by removing footwear.

Causes

Experts are not sure what exactly causes Morton’s neuroma. It seems to develop as a result of irritation, pressure or injury to one of the digital nerves that lead to the toes, which triggers a body response, resulting in thickened nerve tissue (neuroma). Feet conditions/situations that can cause the bones to rub against a nerve include high-heeled shoes, especially those over 2 inches (5cm), or a pointed or tight toe box which squash the toes together. This is probably why the condition is much more common in females than in males. High-arched foot, people whose feet have high arches are much more likely to suffer from Morton’s neuroma than others. Flat feet, the arch of the foot collapses. The entire sole of the foot comes into complete or near-complete contact with the ground. A bunion, a localized painful swelling at the base of the big toe, which enlarges the joint. Hammer toe, a deformity of the proximal interphalangeal joint of the second, third, or fourth toe causing it to be permanently bent. Some high-impact sporting activities including running, karate, and court sports. Any sport that places undue pressure on the feet. Injuries, an injury or other type of trauma to the foot may lead to a neuroma.

Symptoms

Typically, there’s no outward sign of this condition, such as a lump. Instead, you may experience the following symptoms. A feeling as if you’re standing on a pebble in your shoe. A burning pain in the ball of your foot that may radiate into your toes. Tingling or numbness in your toes. It’s best not to ignore any foot pain that lasts longer than a few days. See your doctor if you experience a burning pain in the ball of your foot that’s not improving, despite changing your footwear and modifying activities that may cause stress to your foot.

Diagnosis

Podiatrists conduct a physical examination and may order imaging tests, such as x-ray or MRI scan to diagnose Morton’s neuroma. Conservative treatment options include custom-fitted orthotics, medication, and/or alcohol injections designed to harden the nerve. However, most patients with Morton’s neuroma need minor surgery.

Non Surgical Treatment

To help relieve the pain associated with Morton’s neuroma and allow the nerve to heal, consider the following self-care tips. Take anti-inflammatory medications. Over-the-counter nonsteroidal anti-inflammatory medications, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve), can reduce swelling and relieve pain. Try ice massage. Regular ice massage may help reduce pain. Freeze a water-filled paper cup or plastic foam cup and roll the ice over the painful site. Change your footwear. Avoid high heels or tight shoes. Choose shoes with a broad toe box and extra depth. Take a break. For a few weeks, reduce activities such as jogging, aerobic exercise or dancing that subject your feet to high impact.

Surgical Treatment

Operative treatment of Morton?s neuroma should be entertained only after failure of nonoperative management. Standard operative treatment involves identifying the nerve and cutting (resecting) it proximal to the point where it is irritate/injured. This is usually done through an incision on the top (dorsal) aspect of the foot, although in rare instances, an incision on the sole (plantar) aspect of the foot maybe used. An incision on the sole of the foot works very well, unless an excessive scar forms in which case it can be problematic. Some physicians will attempt to treat Morton?s neuroma by releasing the intermetatarsal ligament and freeing the nerve of local scar tissue. This may also be beneficial.

Prevention

It is not always possible to prevent a Morton’s neuroma. However, you probably can reduce your risk by wearing comfortable shoes that have low heels, plenty of toe space and good arch support.

Advertisements

Posted June 3, 2017 by andraoktavec in Uncategorized