Orthopaedic Clinic: Foot and Ankle
MORTON’S NEUROMA
A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton's neuroma, which occurs at the base of the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma.
"Intermetatarsal" describes its location - in the ball of the foot between the metatarsal bones (the bones extending from the toes to the midfoot). Neuromas may also occur in other locations in the foot.
The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates swelling of the nerve, which leads to permanent nerve damage.
SYMPTOMS
One or more of the following symptoms will be experienced:- Tingling, burning, or numbness
- Pain
- A feeling that something is inside the ball of the foot, or that there's a rise in the shoe or a sock is bunched up.
Morton's Neuroma will progress as follow:
- The symptoms start gradually and occur only occasionally, when wearing narrow-toed shoes or when carrying out certain activities which aggravate the situation.
- The symptoms may be temporarily relieved by massaging the foot or by avoiding aggravating shoes or activities.
- The symptoms worsen over time and may persist for several days or weeks.
- As the neuroma enlarges the symptoms intensify and the temporary changes in the nerve become permanent.
TREATMENT
Your surgeon will first determine how long you have had the neuroma and evaluate its stage of development. Treatment approaches vary according to the severity of the problem.
For mild to moderate cases of neuroma, treatment options include:
- Padding Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
- Icing Placing an icepack on the affected area helps reduce swelling.
- Orthotic devices Custom orthotic devices provided by your foot and ankle surgeon provide the support needed to reduce pressure and compression on the nerve.
- Modify Activity Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
- Changes in footwear It is important to avoid wearing narrow-toed shoes or shoes with heels.
- Medication Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
- Injection therapy If there is no significant improvement after initial treatment, injection therapy may be tried.
SURGERY
Surgery may be considered in patients who do not find relief from other treatments.
There are generally two surgical approaches to treating a neuroma the affected nerve is either removed or released. Your foot and ankle surgeon will determine which approach is best for your condition.
The length of the recovery period will vary, depending on the procedure or procedures performed.
Regardless of whether you have undergone surgical or non-surgical treatment, your foot and ankle surgeon will recommend long-term measures to help keep your symptoms from returning. These include appropriate footwear and modification of activities that cause repetitive pressure on the foot.
