What is Morton’s Neuroma?

A neuroma is a growth that occurs on nerve tissue, sometimes taking the form of a tumor. Morton’s neuroma, however, may not consist of a tumor in the true sense of the word. Many medical specialists who study this condition believe that the growth that occurs in a patient with Morton’s neuroma consists of fibrous tissue and is more properly termed a fibroma. Despite this fact, the name “Morton’s neuroma” has become standardized in the field — though interestingly, the condition was first discovered by a man named Durlacher.

morton's neuroma imageThe condition generally referred to as Morton’s neuroma actually goes by several names, including Morton’s metatarsalgia, intermetatarsal neuroma, Morton’s neuralgia, and plantar neuroma. As these names suggest, Morton’s neuroma involves the plantar nerve in the foot, specifically in the intermetatarsal spaces, a technical phrase that refers to the spaces in between the toes. The most common presentation of Morton’s neuroma is for it to occur in the space between the third and fourth toes. It may occur on either foot and less commonly, may affect spaces between other contiguously located toes.

Patients who have been diagnosed with Morton’s neuroma should not become unduly alarmed. The condition is benign and the nerve growth involved is not cancerous.

Symptoms of Morton’s Neuroma

Patients who may suspect they are suffering from Morton’s neuroma will often feel pain in the feet. This pain takes on several specific forms. It generally occurs only when the patient has placed his or her weight atop the feet; it may occur after only a short period of weight bearing activity. The pain is often described by patients as a shooting sensation rather than a dull ache; it is felt as a sharp pain and usually will affect two toes at once, causing pain in the two halves of the toes that are facing one another.

morton'sAs this presentation of pain is very specific, patients who suffer it and have some understanding of foot conditions may quickly begin to suspect that the problem may be Morton’s neuroma. However, patients should seek a formal diagnosis from a health care professional in order to ascertain whether this exact condition is the culprit and also to obtain up to date treatment information.

Symptoms beyond this specific form of pain may also be present. These include burning and numbness in the foot area, particularly around the toes spaces, as well as the condition formally referred to as paresthesia, which consists of a pricking or tingling sensation in the skin. Commonplace descriptions of paresthesia include the sensation of “pins and needles” or the feeling a limb has when it has “gone to sleep” or begins to wake again. In order for this tingling sensation to qualify as paresthesia, there must be no obvious outward cause for it.

Cramping sensations in the toes may also sometimes be present. Many patients suffering from Morton’s neuroma report that their pain worsens over time and that wearing shoes can cause pain levels to increase, particularly when the shoes are tight or designed in a way that causes them to press against the foot.

Morton’s neuroma can cause lesions to form on the nerve tissue. These lesions have sometimes been present even in patients who demonstrate no other signs of the condition. In such cases, the lesions and the condition both have been diagnosed using magnetic resonance imaging (MRI) technology.

Although Morton’s neuroma usually occurs in the space between the third and fourth toes, it can sometimes present itself as symptoms in the space between the second and third toes instead. This presentation is not at all common. However, if your Morton’s neuroma takes this form, it will be treated in a similar manner to the more standard variety of the condition.

What Causes Morton’s Neuroma

Medical professionals have yet to determine a definite cause for Morton’s neuroma. It may be that a combination of factors is usually required to cause the condition. What is known is that Morton’s neuroma occurs more frequently in women than in men, and that certain risk factors will increase the likelihood of developing the condition.

Some of these risk factors are beyond the control of the individual since they are genetic in nature. This category of risk factors includes:

  • Flat feet
  • Toes that are abnormally positioned
  • Naturally high arches in the foot

Other risk factors relate to other foot problems that may have developed over time. People suffering from problems that affect the front of the foot, such as hammer toes or bunions, for example, are more likely to develop Morton’s neuroma.

As is true of a great many foot conditions, the selection of footwear can be a risk factor for Morton’s neuroma. Tight shoes as well as those with high heels are both considered to contribute to the development of the condition. In patients who already suffer from Morton’s neuroma, these kinds of footwear can make the condition worse.

Complications of Morton’s Neuroma

Patients with Morton’s neuroma can sometimes find walking to be a difficult task. In some cases this complication can become severe enough to interfere with daily life activities, though this tends to be somewhat rare. It often makes such activities more difficult, especially for people who work in fields that require them to be on their feet for a large portion of each day.

Anything that puts pressure on the foot will be more difficult and painful for those suffering from Morton’s neuroma. Some kinds of footwear will no longer be practical for use, including high heeled shoes.

Diagnosis of Morton’s Neuroma

Your health care provider will use a variety of methods to come to a definitive diagnosis of Morton’s neuroma. Most physicians will begin by x-raying the foot, including the toe area, in order to rule out the incidence of underlying bone problems. Since Morton’s neuroma consists of a nerve growth on the plantar nerves in the foot, high level technologies that can “see” inside the tissue of the foot may be needed. Magnetic resonance imaging (MRI) can be used to this end, as can high resolution scans using ultrasound (sound wave) technology. Both of these techniques have been used with success to diagnose instances of Morton’s neuroma.

morton's neuroma treatmentNerve testing, also known aselectromyography, is also sometimes used. While it cannot by itself diagnose Morton’s neuroma with complete certainty, it may be useful to rule out other kinds of nerve conditions that can cause a similar set of symptoms to Morton’s neuroma.

Other tests that may be ordered include blood tests. These are used to check for arthritis and other conditions that can cause inflammation in the joints. Side effects of this inflammation could potentially cause symptoms similar to those that are present in cases of Morton’s neuroma.

Treatment Options for Morton’s Neuroma

As with many other foot conditions, not to mention health issues in general, surgery is generally regarded as a treatment of last resort. The same is true when health care professionals are deciding how to treat Morton’s neuroma. Thankfully, many treatments are available which are nonsurgical in nature.
Your physician may advise the use of any of the following treatment options.

Sometimes treatments are used in combination with one another:

  • Changing footwear to shoes more appropriate for the condition. This may include using shoes with lower heels, eliminating high heels entirely, and wearing shoes with room for the toes to move around instead of being cramped.
  • Inserts added to the interior of shoes.
  • Padding the toe area, sometimes in combination with taping the area in order to hold the padding in place over the course of a day.
  • Anti-inflammatory medications. Often a regimen of NSAIDs will be tried first, to be administered by mouth. A more intensive form of anti-inflammatories can be administered via direct injection into the toe area.
  • Other forms of injections such as nerve blocking medications and corticosteroids. These, like the injected anti-inflammatories will be administered directly into the toe area.
  • Other forms of pain-killing medication.
  • PT — physical therapy.

Long term treatment with medication is not advisable for this condition. Anti-inflammatories and nerve blocking medicines should be used in the short term only, hopefully while other treatment options are in use and helping to remediate the condition.

Surgery as a Treatment Option for Morton’s Neuroma

While it is almost never the treatment option of first resort, sometimes surgery may be necessary to adequately treat Morton’s neuroma. The purpose of such surgical procedures is the removal of thickened tissue that has grown up along the plantar nerve. By removing this tissue, the surgeon can help the patient to realize improvements in the way the foot moves, functions, and feels.

morton's neuroma surgeryAn unfortunate side effect of the surgical procedure used to treat Morton’s neuroma is numbness. This is quite common and is to be somewhat expected, given that the surgery involves the nerves in the foot. Numbness after Morton’s neuroma surgery tends to be a permanent condition, but the patient will be relieved of the pain that was previously experienced.

Surgery in cases of Morton’s neuroma has a high success rate. Although some patients continue to suffer from the condition, they represent only about 15% of surgical patients. In approximately 85% of cases, the surgery produces a positive outcome.

Neurectomy Surgery

The most commonly used surgery to treat Morton’s neuroma is a neurectomy. This procedure involves removing a portion of nerve tissue in the affected area. The reason why surgery sometimes fails to eliminate all symptoms is the fact that scar tissue can form at the site of the procedure. This post operative scar tissue is called a “stump neuroma.” While the technical condition of Morton’s neuroma will no longer exist, similar symptoms can occur in patients with a stump covering the site of the original neuroma. Thus, a small percentage of patients continue to suffer pain, tingling, and numbness.

Cryogenic Neuroablation Surgery

An alternative to a neurectomy is a procedure called cryogenic neuroablation.  Also known as cyro injection therapy and cryosurgery, this procedure involves the application of extreme cold temperatures to the nerves in order to destroy axons. Without axons, the nerve tissue cannot transmit pain signals and thus the patient will perceive pain as having been relieved. The temperatures required to destroy nerve tissues range from 50 degrees below zero to 70 degrees below zero, as measured on the Celsius scale. The cold causes several nerve elements to degenerate, including both axons and the myelin sheath which houses the nerve. However, other structures in the area will not be destroyed — this is what distinguishes the cryogenic neuroblation procedure from neurectomy.

Because cryogenic neuroblation is less destructive of tissue, it does not lead to the development of stump neuroma as neurectomy can. This means that patients that have had this procedure are less likely to see a recurrence of their neuroma symptoms. At the same time, the cryogenic procedure appears to be just as effective as surgery in terms of adequate outcomes. For these reasons, some surgeons strongly prefer cryogenic neuroblation to surgery.

When to Call Your Health Care Professional

Any persistent sensation of pain in the foot or toe should be a cause for concern. Even if there is no pain present but there is significant tingling, particularly in the seemingly empty spaces between the toes, you should contact your physician or local clinic to begin the diagnostic procedures that will determine if you might have Morton’s neuroma.

Prevention of Morton’s Neuroma

Some risk factors for the condition of Morton’s neuroma cannot be avoided. However, there are some things that individuals can do to minimize their chances of developing this painful and debilitating condition.

  • Wear shoes that fit properly, paying particular attention to their width. Tight, narrow shoes stress the foot and increase the likelihood of Morton’s neuroma.
  • Avoid high heeled shoes.
  • Be certain that your shoes have enough room for the toes to move freely, both in  lateral (side to side) and vertical (up and down) motions.