Morton?s neuroma is a swollen nerve in the distal portion of the foot. The enlarged portion of the nerve represents scarring within the plantar nerve that occurs after chronic compression and/or repetitive injury. This may come about when the toes are squeezed together for too long, as can occur with the chronic use of high heels. The nerve that runs between your toes will swell and thicken. This can cause pain when walking. The symptoms of Morton?s neuroma can include burning pain in the foot, the feeling of a lump inside your foot, pain between the third and fourth toes typically but it can occur between other toes.
Wearing shoes that are too tight can make the pain of Morton's neuroma worse. This is because the toe bones are more likely to press on the affected nerve if your shoes are too tight. High-heeled shoes, particularly those over 5cm (2 inches), or shoes with a pointed or tight toe area, can also compress your toes and make the pain worse. This is why women tend to be affected by Morton's neuroma more than men.
Morton?s neuroma is a progressive condition which means the symptoms typically get worse over time. Initially people often complain of a tingling or numbness at the base of their toes, typically in the space between the third and fourth toes, or, less commonly , between the second and third toes, which feels a bit like pins and needles. Over time the pain progresses and can feel like a stabbing or burning sensation in the ball of the foot under the toes. Some describe it as feeling as if they are standing on a stone. Normally the pain will get worse when you wear tight fitting shoes. Doing exercise that impacts on the foot such as jogging can also make the symptoms worse. The extent of the pain varies from person to person but in some cases it can be so intense that every step can feel acutely painful.
The doctor will ask about your symptoms and medical history. A physical exam will be done. Initial diagnosis of Morton's neuroma is based on your description of the type and location of pain and discomfort in the foot. The diagnosis will be confirmed by a physical exam of the foot, including checking for mechanical abnormalities in the foot, squeezing the side of the foot, which will usually cause pain when Morton's neuroma is present. Examination of your shoes to check for excess wear in parts of the shoe, check to see whether the shoes are too tight. Imaging tests evaluate the foot and surrounding structures. This may be done with X-ray, MRI scan, Ultrasound. Injections of local anesthetic can also be used for diagnosis.
Non Surgical Treatment
If symptoms are severe or persistent and self-help measures did not help, the doctor may recommend corticosteroid injections, a steroid medication that reduces inflammation and pain is injected into the area of the neuroma. Only a limited number of injections are advised, otherwise the risk of undesirable side effects increases, including hypertension (high blood pressure) and weight gain. Alcohol sclerosing injections, studies have shown that alcohol injections reduce the size of Morton's neuromas as well as alleviating pain. This is a fairly new therapy and may not be available everywhere. The doctor injects alcohol in the area of the neuroma to help sclerose (harden) the nerve and relieve pain. Injections are typically administered every 7 to 10 days. For maximum relief 4 to 7 injections are usually needed.
Recently, an increasing number of procedures are being performed at specialist centers under radiological or ultrasound guidance. Recent studies have shown excellent results for the treatment of Morton's neuroma with ultrasound guided steroid injections, ultrasound guided sclerosing alcohol injections, ultrasound guided radiofrequency ablation and ultrasound guided cryo-ablation.