Morton’s Neuroma
Morton’s Neuorma is thickening of the nerve that occurs between the metatarsal heads at the ball of the foot. The nerve develops an onion bulb swelling before it splits to inner side of two adjacent toes. The nerve gets compressed and causes the neuroma symptoms. The neuroma affects the ball of the foot and radiates into the toes. The most common interspace for the neuroma to occur is the 3rd followed by the 2nd interspace radiating into their associated toes. The swelling can cause a clicking sensation called Mulder’s sign.
Classic complaint of the patient is numbness of the 3rd or 2nd interspace which radiates into the associated toes with activity. The patient wants to take off their shoe rub the area to resolve the numbness, start walking again and the numbness re occurs.
Symptoms-Numbness, tingling, burning, sharp shooting pain, clicking, feels like something is bunched up in the shoe like the sock.
Cause-Foot biomechanics, trauma, shoes-narrow/high heels, stress on the ball of the foot.
Diagnosis-History and physical examination of the foot, Podiatrist tries to reproduce the symptoms through palpation and compression of the area. Ultrasound or MRI.
Prevention and treatment;
Alteration of shoe gear- avoid narrow/tight in forefoot shoes, high heels.
Padding-metatarsal pad or neuroma strip pad.
Activity-modify/eliminate activity that aggravates the neuroma.
Custom orthotics to control the abnormal biomechanics and help alleviate the neuroma symptoms. Accommodative padding is usually added to the custom orthotic like a neuroma strip pad or metatarsal pad.
Injection of cortisone or diluted alcohol.
Physiotherapy
Ice, anti-inflammatories.
If conservative treatment is not successful in relieving the symptoms then one can consider surgery. There are many possibly risks and complications and extended post op course in having surgery so one should be able to accept the consequences if the surgery does not go well.
