Morton’s neuroma occurs in the forefoot when fibrous tissue building up inside a sensory nerve that goes to the toes. Symptoms include sporadic pain in the ball of the foot between the base of the third and fouth or second and third toes. Not all neuromas are painful but it can be associated with pain on the bottom of the forefoot , sometimes burning or numbness to the toes. It may feel as if there is a lump or a marble just beneath the ball of your foot. Pain is often soothed by taking weight off the foot or by massaging the area.
In the forefoot, there are the long bones (metatarsals) and thin nerves running between them. The nerves split in a Y-shape when they reach the toes. Rubbing of the nerve against a ligament or perhaps the metatarsals causes inflammation and eventually, fibrous tissue and nerve damage. Morton’s neuroma is the most common of this type of nerve problem, affecting the nerve between the third and fourth toes, but can also be between the second an third tors. Neuromas may also occur after a nerve has been injured, either from a traumatic wound or from damage suffered during surgery but these are not called Morton’s neuromas.
Diagnosis of Morton’s Neuroma
Dr Deland may be able to diagnose Morton’s neuroma upon a physical examination. The exam may include pressing in the appropriate webspace or squezzing to produce a click like sensation. Palpation of adjacent bones , plantar plates and the tarsal tunnel is used to exclude other diagnoses. An mri or ultrasound can be used to measure the size of the neuroma. If needed a lidocaine injection test possibly with ultrasound can be used to confirm the correct webspace. It is possible to have two neuromas in the same foot as Dr Deland pointed out in a publication. However, it is usually only one of the neuromas that is causing the pain.
Morton’s Neuroma Treatment
Conservative treatment with alternative shoewear can be used. A cortisone injection can be used to treat the pain temporarily but is not a cure and probably should not be traeated as it can attenuate the skin or plantar fat pad. Good skin is important in heal in case surgery is needed. Loss of the plantar fat pad locally on the ball of the foot, if it occurs, is permanent and can be painful. Cryotherapy is also usually not recommended. If it provides relief, relief is only temporary and the cold can damage the skin.
If conservative treatments do no relieve the symptoms, surgery can provide good pain relief if properly performed. Diagnoses such as plantar plate injury or prominent metatarsal head must be excluded. A good physical exam must be done to confirm the diagnosis and correct websplace. MRI or ultrasound is done if diagnosis or choice of webspace is uncertain. In the correct patient, a properly performed surgery has a high chance of success. Dr. Deland can determine if the patient is the right patient for the procedure, properly perform the procedure, and achieve success for the patient. Recovery allows immediate weight bearing and transition to a sneaker at two weeks.
Other Conditions
