Mortons Neuroma is a common painful condition involving compression of nerves between the long bones of the forefoot just before they enter the toes. Commonly this involves the 3rd and 4th toes, however may affect the 2nd and 3rd toes. Repeated trauma or compression of these nerves causes the nerves to swell and thicken causing a Morton's neuroma to develop.
Inappropriate footwear is one of the principle causes of Morton?s neuroma. Toe spring and tapering toe boxes are the most problematic shoe design features that contribute to this health problem. Morton?s neuroma occurs when one of your nerves is stretched and pinched, which happens with great frequency in people who wear shoes incorporating these design features. A professional shoe fitting should always be sought if you are struggling with neuroma-related symptoms.
Patients with a Morton's neuroma typically experience a sharp, shooting or burning pain, usually at the base of the forefoot or toes, which radiates into the two affected toes. Sometimes the pain may also radiate into the foot. The pain is often associated with the presence of pins and needles and numbness.
During the exam, your doctor will press on your foot to feel for a mass or tender spot. There may also be a feeling of "clicking" between the bones of your foot. Some imaging tests are more useful than others in the diagnosis of Morton's neuroma. Your doctor is likely to order X-rays of your foot, to rule out other causes of your pain such as a stress fracture. Ultrasound. This technology uses sound waves to create real-time images of internal structures. Ultrasound is particularly good at revealing soft tissue abnormalities, such as neuromas. Magnetic resonance imaging (MRI). Using radio waves and a strong magnetic field, an MRI also is good at visualizing soft tissues. But it's an expensive test and often indicates neuromas in people who have no symptoms.
Non Surgical Treatment
Treatment depends on the severity of your symptoms. Your doctor will likely recommend trying conservative approaches first. Arch supports and foot pads fit inside your shoe and help reduce pressure on the nerve. These can be purchased over-the-counter, or your doctor may prescribe a custom-made, individually designed shoe insert, molded to fit the exact contours of your foot.
About one person in four will not require any surgery for Morton's neuroma and their symptoms can be controlled with footwear modification and steroid/local anaesthetic injections. Of those who choose to have surgery, about three out of four will have good results with relief of their symptoms. Recurrent or persisting (chronic) symptoms can occur after surgery. Sometimes, decompression of the nerve may have been incomplete or the nerve may just remain 'irritable'. In those who have had cutting out (resection) of the nerve (neurectomy), a recurrent or 'stump' neuroma may develop in any nerve tissue that was left behind. This can sometimes be more painful than the original condition.