What is a Morton's Neuroma?
A neuroma is the swelling of a nerve due to a trauma or compression. That swelling within the nerve may lead to a permanent nerve damage. The most prevalent site for a neuroma is on the ball of the foot. The most common cause of neuroma in ball of the foot is the stress and abnormal movement of the long bones behind the toes called metatarsal bones. A puncture wound or laceration that injures one of the nerves can cause a neuroma..A small nerve passes between the spaces of the metatarsals. At the base of the toes, the nerves split forming a "Y" and enter the toes. It is in this area the nerve gets pinched and swells, forming the neuroma. Burning , sharpening , dull or throbbing pain are common symptoms. Taking off the shoe and rubbing the ball of the foot helps to relieve the pain. As the nerve swells, it can be felt as a popping sensation when walking. Pain is intermittent and is aggravated by anything that results in further pinching of the nerve. When the neuroma is present in the space be-tween the third and fourth toes, it is called a Morton's Neuroma. This is the most common area for a neuroma to form. Another, but unfrequent neuromas can be Joplin´s neuromas, which are rare neuro-mas, involving the proper digital nerve of the big toe .
Physical examination, key for proper diagnosis
Your podiatrist will diagnose the neuroma and will carry out a physical examination or biome-chanical assesment. Conditions that mimic the pain associated with Neuromas are shorter first meta-tarsal bone, stress fracture of the metatarsals, inflammation of the tendons in the bottom of the toes, joint artrhitis , or nerve compression or nerve damage further up in the foot, ankle, knee, hip, or back. X-rays are generally taken to rule out a possible stress fracture or arthritis. The x-ray will not show the neuroma. A skilled podiatrist o physician will be able to actually feel the neuroma while examing your feet. Special studies such as ultrasoundgraphy, MRI or nerve conduction studies have little value in the diagnosis of a neuroma. Additionally, these studies can be pricey and generally the results do not alter our treatment plan.
Conservative treatment as first step:
Conservative treatment must be taken into account as first step . If it fails, then surgical pro-cedures should be considered
The primary aim of the treatment is to relief the mechanical stress from the metatarsal heads where the neuroma develops, which are subjected to a high pressure.Treatment for the neuroma con-sists on cortisone or colagen(is getting popular in some countries , with good results) injections or chemical destruction of the nerve. Cortisone injections could be used as an initial form of treatment. Cortisone may be useful when injected around the nerve, because is can shrink the swelling of the nerve. This relieves the pressure on the nerve. Cortisone may provide relief for many months, but is often not a cure for the condition. The abnormal movements of the metatarsal bones continue to ag-gravate the condition over a period of time, so we need to ask patients to get some cushion-sole shoes with a wide toe box is often adequate treatment to mitigate the symptoms.Moreover, the use of foot orthosis should be considered the vast majority of times. However, for severe conditions and when the conservative treatment fails, surgery should be considered to remove the tumor.
Special padding at the ball of the foot may change the abnormal feet mechanics and relieve the symp-toms caused by the neuroma.
Home Treatment, what can you do for relief?
• Wear shoes with plenty of room for the toes to move, low heels, and laces or buckles that al-low for width adjustment.
• Wear shoes with thick, shock-absorbent soles, as well as proper foot orthosis that are de-signed to relief the pressure off of the foot.
• High-heeled shoes over two inches tall should be avoided
• Resting the foot and massaging the affected area
• Use over-the-counter shoe pads. Padding can relieve pressure around the affected area.
• Make sure your trainers or sport shoes have enough room in the front part of the shoe and that your toes are not excessively compressed.
• Wear shoes with adequate cushioning sole in the ball of the foot.
• Avoid prolonged time in shoes with a narrow toe box or excessive heel height (greater than two inches).
We recommend that people experiencing this condition, should have a biomechanical exami-nation at least once a year. At Randell’s Footcare we have a fantastic biomechanics podiatry team who strongly believe in prevention as the best way to keep our bodies and feet in great condition.
You should visit a podiatrist at the first sign of pain or discomfort. If left untreated, neuromas tend to get worse.
biomechanics, feet, pain, shoes
Iván Maestre, HCPC registered podiatrist at Randell’s Footcare