Common Foot Problems

What Is Morton's Neuroma?

A neuroma is an inflamed nerve that can occur at any point along a nerve. Morton's neuroma - the most common type of foot neuroma - affects the interspace between the third and fourth toes. Intermetatarsal neuroma is another name for this condition, as it is located in the ball of the foot between the metatarsal bones. Neuromas also occur less commonly in other areas of the foot.

The inflammation of a neuroma is caused by stress and irritation to a part of the nerve. This stress causes the nerve to inflame and may eventually lead to permanent nerve damage.

Any physical contact compressing or irritating the nerve may cause a neuroma to develop. Wearing high-heeled shoes, or shoes with a tapered toe box is the most common contributor to neuromas. With improper shoes, toes are forced in the toe box, causing close contact and aggravating the nerve.

Other risk factors include foot deformities such as bunions, hammertoes, flat feet or more flexible feet. These conditions cause abnormal foot motion that leads to nerve irritation. People should also be wary of activites that involve repeated impact to the ball of the foot, such as running or tennis. Previous trauma or injury to the nerve can also cause a neuroma.

A Morton's neuroma involves at least one of the following symptoms at the site of nerve damage:

  • Tingling, burning or numbness.
  • Sharp or shooting pain.
  • A feeling that something is in the ball of the foot.
  • A feeling that something is in the shoe or a sock is bunched up.

The symptoms of a Morton's neuroma begin gradually, occurring only when wearing improper shoes or participating in high impact activities. Temporary relief may be felt by removing the shoe, massaging the foot or avoiding aggravating shoes and activities. Gradually, the symptoms become more severe and may last for several days or weeks. Symptoms increase in severity as the nerve becomes more inflamed and the temporary changes turn into permanent nerve damage.

Dr. Radovic will perform a complete medical history and a physical examination of the foot to reach a diagnosis. For the physical examination, Dr. Radovic tries to recreate the symptoms by palpating the foot and testing range of motion.

Patients should consult Dr. Radovic when their symptoms first begin to develop. When diagnosed early, Morton's neuroma may require less invasive treatment options. In fact, surgery may be avoided altogether.

To determine a treatment plan, Dr. Radovic will first assess when the neuroma developed and its stage of development. Treatments vary according to the severity of the neuroma.

The treatment options for neuromas in mild to moderate stages include:

  • Padding techniques to support the metatarsal arch and lessen pressure and stress on the nerve when walking.
  • Applying an ice pack to reduce swelling in the affected area.
  • Custom orthotics casted by Dr. Radovic support the foot to decrease stress on the nerve.
  • Avoiding high impact activities that cause repetitive pressure to the nerve, until the neuroma improves.
  • Wearing shoes with a wide toe box and avoiding pointed-toed shoes and high heels.
  • Taking oral nonsteroidal anti-inflammatory drugs (NSAIDs) including Aspirin and Ibuprofen for relief from pain and inflammation.

Surgery becomes an option for patients whose symptoms persist despite non-surgical treatments. Dr. Radovic will determine the most suitable surgical approach on a case-by-case basis. Patient will recover at different rates depending on the procedure performed.

Both surgical and nonsurgical treatments require taking long-term measures to prevent symptoms from returning. Shoe modifications and activity modifications are among the supplemental approaches taken for long term relief from neuromas.

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