A Morton?s Neuroma is actually incorrectly termed, with the name suggesting it is a tumour or growth. Rather than a true neuroma it is actually what is called a perineural fibrosis, which means that over time the sheath surrounding the nerve becomes irritated, inflamed, and forms a thickened scar tissue.
Some experts believe that other foot conditions may also be associated with Morton's neuroma. This is because other conditions may cause the metatarsal bones to rub against the nerve in your foot. Foot problems that may increase your risk of developing Morton's neuroma include abnormally positioned toes, high arches, where the arch or instep of your foot is raised more than normal, flat feet, low arches or no arches at all, bunions a bony swelling at the base of the toe. Hammer toe, where the toe is bent at the middle joint. Being active and playing sport can make the painful symptoms of Morton's neuroma worse. In particular, running or sports that involve running, such as racquet sports, can place extra pressure on the nerve in your foot, which can aggravate the problem.
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 physician will make the diagnosis of Morton's neuroma based upon the patient's symptoms as described above in an interview, or history, and a physical examination. The physical examination will reveal exceptional tenderness in the involved interspace when the nerve area is pressed on the bottom of the foot. As the interspace is palpated, and pressure is applied from the top to the bottom of the foot, a click can sometimes be felt which reproduces the patient's pain. This is known as a Mulder's sign. Because of inconsistent results, imaging studies such as MRI or ultrasound scanning are not useful diagnostic tools for Morton's neuroma. Thus the physician must rely exclusively on the patient's history and physical examination in order to make a diagnosis.
Non Surgical Treatment
Most non-operative treatment is usually successful, although it can take a while to figure out what combination of non-operative treatment works best for each individual patient. Non-operative treatment may include the use of comfort shoe wear. The use of a metatarsal pad to decrease the load through the involved area of the plantar forefoot. A period of activity modification to decrease or eliminate activities, which may be exacerbating the patient?s symptoms. For example, avoiding long periods of standing or other activities that result in significant repetitive loading to the forefoot can be very helpful. Wearing high heels should be avoided. Local can help decrease inflammation associated with the nerve. However, this does not necessarily address the underlying loading forces that maybe causing the injury to the nerve in the first place. It has been proposed that an alcohol injection in and around the nerve will cause a controlled death to the nerve and subsequently eliminate symptoms. In theory, this may be helpful. In practice, adequate prospective studies have not demonstrated the benefit of this procedure above and beyond the other standard, non-operative treatments available. In addition there is the concern that the alcohol will cause excessive scarring and damage to other important structures in the area.
Surgery for Morton's neuroma is usually a treatment of last resort. It may be recommended if you have severe pain in your foot or if non-surgical treatments haven't worked. Surgery is usually carried out under local anaesthetic, on an outpatient basis, which means you won't need to stay in hospital overnight. The operation can take up to 30 minutes. The surgeon will make a small incision, either on the top of your foot or on the sole. They may try to increase the space around the nerve (nerve decompression) by removing some of the surrounding tissue, or they may remove the nerve completely (nerve resection). If the nerve is removed, the area between your toes may be permanently numb. After the procedure you'll need to wear a special protective shoe until the affected area has healed sufficiently to wear normal footwear. It can take up to four weeks to make a full recovery. Most people (about 75%) who have surgery to treat Morton's neuroma have positive results and their painful symptoms are relieved.
Always warm-up thoroughly before vigorous athletics. Avoid activities that cause pain. Stretch and strengthen the feet through gradual exercise.