Diagnosing Mortons Neuroma
Overview
A neuroma develops when a nerve is compressed, injured or pinched, causing swelling and pain. A neuroma in the area between the third and fourth toes, or between the second and third toes, is known as a Morton?s neuroma. Morton?s neuroma causes sharp, burning pain and numbness in the toes and foot. You may feel like you?ve stepped on a tiny hot coal and can?t get rid of it. At the same time, you?ll have the disconcerting experience of not being able to feel your toes. Sometimes the nerve tissue becomes so thickened you can feel or see a lump.
Causes
The exact cause is as yet unclear. However there are a number of theories. Some expert s believe problems with the design of the foot makes some people more prone to Morton?s neuroma. Having flat feet or a high arch for example encourages the foot to slide forwards which can put excess pressure on the metatarsals. Bunions and hammer toes also increase the likelihood of developing Morton?s. However simply wearing high heels or any form of tight shoes that put pressure on the bones in the feet can also lead to a Morton?s . Typically the condition comes on between the age of 40 and 50. It is far more common in women than men - three out of four sufferers are women.
Symptoms
A Morton's neuroma usually causes burning pain, numbness or tingling at the base of the third, fourth or second toes. Pain also can spread from the ball of the foot out to the tips of the toes. In some cases, there also is the sensation of a lump, a fold of sock or a "hot pebble" between the toes. Typically, the pain of a Morton's neuroma is relieved temporarily by taking off your shoes, flexing your toes and rubbing your feet. Symptoms may be aggravated by standing for prolonged periods or by wearing high heels or shoes with a narrow toe box.
Diagnosis
Based on the physical examination, your doctor usually can diagnose a Morton's neuroma without additional testing. A foot X-ray may be ordered to make sure that there isn't a stress fracture, but it will not show the actual neuroma. If the diagnosis is in doubt, your doctor may request magnetic resonance imaging (MRI) of the foot.
Non Surgical Treatment
Simple treatments may be all that are needed for some people with a Morton's neuroma. They include the following. Footwear adjustments including avoidance of high-heeled and narrow shoes and having special orthotic pads and devices fitted into your shoes. Calf-stretching exercises may also be taught to help relieve the pressure on your foot. Steroid or local anaesthetic injections (or a combination of both) into the affected area of the foot may be needed if the simple footwear changes do not fully relieve symptoms. However, the footwear modification measures should still be continued. Sclerosant injections involve the injection of alcohol and local anaesthetic into the affected nerve under the guidance of an ultrasound scan. Some studies have shown this to be as effective as surgery.
Surgical Treatment
If conservative treatments haven't helped, your doctor might suggest injections. Some people are helped by the injection of steroids into the painful area. In some cases, surgeons can relieve the pressure on the nerve by cutting nearby structures, such as the ligament that binds together some of the bones in the front of the foot. Surgical removal of the growth may be necessary if other treatments fail to provide pain relief. Although surgery is usually successful, the procedure can result in permanent numbness in the affected toes.
A neuroma develops when a nerve is compressed, injured or pinched, causing swelling and pain. A neuroma in the area between the third and fourth toes, or between the second and third toes, is known as a Morton?s neuroma. Morton?s neuroma causes sharp, burning pain and numbness in the toes and foot. You may feel like you?ve stepped on a tiny hot coal and can?t get rid of it. At the same time, you?ll have the disconcerting experience of not being able to feel your toes. Sometimes the nerve tissue becomes so thickened you can feel or see a lump.Causes
The exact cause is as yet unclear. However there are a number of theories. Some expert s believe problems with the design of the foot makes some people more prone to Morton?s neuroma. Having flat feet or a high arch for example encourages the foot to slide forwards which can put excess pressure on the metatarsals. Bunions and hammer toes also increase the likelihood of developing Morton?s. However simply wearing high heels or any form of tight shoes that put pressure on the bones in the feet can also lead to a Morton?s . Typically the condition comes on between the age of 40 and 50. It is far more common in women than men - three out of four sufferers are women.
Symptoms
A Morton's neuroma usually causes burning pain, numbness or tingling at the base of the third, fourth or second toes. Pain also can spread from the ball of the foot out to the tips of the toes. In some cases, there also is the sensation of a lump, a fold of sock or a "hot pebble" between the toes. Typically, the pain of a Morton's neuroma is relieved temporarily by taking off your shoes, flexing your toes and rubbing your feet. Symptoms may be aggravated by standing for prolonged periods or by wearing high heels or shoes with a narrow toe box.
Diagnosis
Based on the physical examination, your doctor usually can diagnose a Morton's neuroma without additional testing. A foot X-ray may be ordered to make sure that there isn't a stress fracture, but it will not show the actual neuroma. If the diagnosis is in doubt, your doctor may request magnetic resonance imaging (MRI) of the foot.
Non Surgical Treatment
Simple treatments may be all that are needed for some people with a Morton's neuroma. They include the following. Footwear adjustments including avoidance of high-heeled and narrow shoes and having special orthotic pads and devices fitted into your shoes. Calf-stretching exercises may also be taught to help relieve the pressure on your foot. Steroid or local anaesthetic injections (or a combination of both) into the affected area of the foot may be needed if the simple footwear changes do not fully relieve symptoms. However, the footwear modification measures should still be continued. Sclerosant injections involve the injection of alcohol and local anaesthetic into the affected nerve under the guidance of an ultrasound scan. Some studies have shown this to be as effective as surgery.
Surgical Treatment
If conservative treatments haven't helped, your doctor might suggest injections. Some people are helped by the injection of steroids into the painful area. In some cases, surgeons can relieve the pressure on the nerve by cutting nearby structures, such as the ligament that binds together some of the bones in the front of the foot. Surgical removal of the growth may be necessary if other treatments fail to provide pain relief. Although surgery is usually successful, the procedure can result in permanent numbness in the affected toes.
