If you sometimes feel that you are “walking on a marble,” and you have persistent pain in the ball of your foot, you may have a condition called Morton’s neuroma. A neuroma is a benign tumor of a nerve. Morton’s neuroma is not actually a tumor, but a thickening of the tissue that surrounds the digital nerve leading to the toes. Morton’s neuroma occurs as the nerve passes under the ligament connecting the toe bones (metatarsals) in the forefoot. Morton’s neuroma most frequently develops between the third and fourth toes, usually in response to irritation, trauma or excessive pressure. The incidence of Morton’s neuroma is 8 to 10 times greater in women than in men.
Unfortunately, the cause of Morton?s Neuroma remains unknown to researchers. It is likely that a variety of factors may play a role in the development of this condition, including the presence of chronic pain conditions like fibromyalgia. Factors that may contribute to the development of Morton?s Neuroma include Wearing improperly fitting shoes can cause pressure on your foot, leading to swelling around the toe nerves. High heels are of particular concern as they cause a large amount of weight to be shifted to the ball of the foot. Repetitive activities like jogging, walking, and aerobics can also place a lot of pressure on the feet. This could lead to Morton?s Neuroma. Having a previous foot or muscle injury may cause you to hold your foot in a poor position when walking, contributing to nerve inflammation. Some people are just born with poorly shaped feet. People with extremely low arches or “flat feet” may suffer from Morton?s Neuroma more than others.
A Morton’s neuroma causes a “burning” sharp pain and numbness on the bottom of the foot in the involved area, and this pain and numbness can radiate to the nearby toes. The pain is usually increased by walking or when the ball of the foot is squeezed together and decreased with massaging. It may force a person to stop walking or to limp from the pain.
The exact cause of Mortons neuroma can often vary between patients. An accurate diagnosis must be carefully made by the podiatrist through thorough history taking and direct questioning to ensure all possible causes are addressed. The podiatrist will also gather further information about the cause through a hands on assessment where they will try to reproduce your symptoms. A biomechanical and gait analysis will also be performed to assess whether poor foot alignment and function has contributed to your neuroma.
Non Surgical Treatment
Conservative treatment for Morton?s neuroma involves footwear that allows your forefoot to spread. High-heeled shoes cause neuromas by squeezing and stretching your involved intermetatarsal nerve across the ball of your foot and should be avoided as often as possible. A shoe that possesses any toe spring will also place more stress on your foot nerves and increase your likelihood of developing a neuroma. Test shoes before you buy them to see if they are appropriate for your feet. Select shoes that have a removable liner or insole, and stand on the liner, noting the position of your foot. If your foot is wider than your liner, that shoe will irritate your neuroma by squeezing your metatarsal bones together.
If these non-surgical measures do not work, surgery is sometimes needed. Surgery normally involves a small incision (cut) being made on either the top, or the sole, of the foot between the affected toes. Usually, the surgeon will then either create more space around the affected nerve (known as nerve decompression) or will cut out (resect) the affected nerve. If the nerve is resected, there will be some permanent numbness of the skin between the affected toes. This does not usually cause any problems. You will usually have to wear a special shoe for a short time after surgery until the wound has healed and normal footwear can be used again. Surgery is usually successful. However, as with any surgical operation, there is a risk of complications. For example, after this operation a small number of people can develop a wound infection. Another complication may be long-term thickening of the skin (callus formation) on the sole of the foot (known as plantar keratosis). This may require treatment by a specialist in care of the feet (chiropody).