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.
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.
As 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.
Nerve 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.
An 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.
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.
Recommended Morton’s Neuroma Products
Most of the products recommended for use by patients suffering from Morton’s neuroma fall into the orthotics category. By placing inserts in the shoes, patients can obtain some relief of symptoms while other treatment options such as physical therapies are undertaken.
These orthotic inserts consist of a cushion filled with silicone gel, providing a soft surface that will help reduce the pressure from the toes. The silicone is of particular use to relieve the burning and pain that may be associated with the condition of Morton’s neuroma.
Designed with the anatomy of the human foot in mind, the pad serves to support the ball of the foot while the patient is standing or walking. One of their most useful features is their durability, which is due in part to high quality materials and in part to the inclusion of a toe loop that is reinforced so that the pads will last a long time. These pads are both washable and reusable and come in a convenient single size fits all formulation.
Manufactured by orthotics expert FootSmart, this sleeve for the front of the foot comes in two sizes: large and medium. Features include an interior gel pad filled with extra-soft gel to provide a high degree of cushioning. The sleeve is elasticized so that it will stretch around the foot, conforming to the natural curve of the patient’s toes.
This not only provides a comfortable fit, it helps assure that the sleeve will stay in place throughout the length of the day. Additional assurance is provided by the top loop that goes around the toe, keeping the gel pad properly positioned. This is important, since orthotics that slide out of place will cause a sudden recurrence of pain, which can be dangerous when it happens unexpectedly. The FootSmart Metatarsal Sleeve is made from 30% rubber and 70% nylon, while the gel pad is filled with TPE gel.
Long lasting and durable, the FootSmart Metatarsal Sleeve is also easy to care for. Merely wash it by hand in warm water, using a mild soap or detergent, and rinse thoroughly. After this the foot sleeve should be allowed to air dry thoroughly.
Please note: these foot sleeves are not recommended for people with poor circulation or those who suffer from diabetes. Neither should the foot sleeves be worn 24 hours a day. Allow at least 3 or 4 hours each day for your feet to breathe free without the sleeves. Going barefoot during this time is recommended.
These pads come in several sizes and are designed to help reduce the symptoms of both Morton’s neuroma and bursitis. By lifting the middle three toes, the pads serve to reduce the stress normally placed on the metatarsal area of the forefoot.