What is Mortons Neuroma?
Morton’s Neuroma is a common foot condition that involves a thickening of the tissue around the nerves leading to the toes. This can cause pain, numbness, and a sensation of stepping on a lump or something inside the ball of the foot. It is often linked to wearing tight or high-heeled shoes, excessive pressure on the feet, or repetitive stress from activities such as running or jumping. This condition more commonly affects the area between the third and fourth toes and is more prevalent in women. Treatment can include wearing supportive footwear, using orthotic devices, or in severe cases, surgery may be necessary to remove the affected nerve. Understanding the symptoms and causes of Morton’s Neuroma is crucial in seeking appropriate treatment and alleviating discomfort.
These symptoms usually worsen over time if left untreated, and can greatly impact a person’s ability to walk and perform daily activities. However, there are ways to relieve the symptoms of Morton’s neuroma, such as wearing wider, more comfortable shoes to reduce pressure on the affected area. Orthotic devices or padding may also help to alleviate discomfort. In some cases, a doctor may recommend corticosteroid injections or physical therapy to help manage the symptoms. If conservative treatments don’t provide relief, surgery may be an option to remove the neuroma and relieve the associated pain.
Clinical tests are often used to diagnose this condition and the most sensitive tests include the thumb index finger squeeze test, Mulder’s click test, and foot squeeze test.
X-rays are often the first imaging test used to rule out other causes of forefoot pain, such as stress fractures or arthritis. While X-rays do not show soft tissue abnormalities, they can help identify bone abnormalities or joint dislocations.
Ultrasound is a valuable imaging test for Morton’s neuroma as it can clearly visualize soft tissues, including the nerve and surrounding structures. It is particularly useful in identifying the characteristic neuroma mass and assessing its size and location.
Magnetic resonance imaging (MRI) provides detailed images of the soft tissues surrounding the nerves and can accurately depict the size and location of the neuroma. It is especially helpful in diagnosing Morton’s neuroma in cases where the ultrasound findings are inconclusive.
Non-Operative Management Options
Orthotics and insoles
Proper use of orthotics and insoles is essential for Morton’s neuroma treatment. For metatarsal support, use insoles with a Metatarsal Bar, which helps distribute pressure evenly and reduce strain on the affected area. Additionally, wearing shoes with a broad toe box provides extra room for the toes, reducing compression on the metatarsals.
Positioning foam or fabric pads under the affected metatarsals can also help alleviate discomfort and provide added support. It’s important to ensure that the orthotics and insoles are properly fitted and positioned to maximize their effectiveness.
Compliance is crucial for successful treatment, so it’s important to wear the orthotics and insoles consistently and as prescribed by a healthcare professional.
Anti-Inflammatory Medication/Corticosteroid Injections
Anti-inflammatory medication and corticosteroid injections are commonly used in the treatment of Morton’s neuroma to reduce pain and inflammation. Anti-inflammatory medication, such as ibuprofen or naproxen, helps to lessen the swelling and pain associated with the neuroma. Corticosteroid injections are used to reduce inflammation and provide pain relief by targeting the affected nerve. While these treatments can be effective in providing short-term relief, their long-term effectiveness is limited. Potential side effects of corticosteroid injections include fat pad atrophy, skin pigmentation changes, and nerve damage.
Surgical Excision
The surgical excision of Morton neuroma can be performed using either the dorsal or plantar approach. The dorsal approach involves accessing the neuroma through the top of the foot, while the plantar approach involves accessing it through the bottom. Studies have shown that both approaches have similar success rates, with approximately 80-85% of patients experiencing pain relief and improved function post-operatively. However, the plantar approach may result in less discomfort during the initial recovery period.
Overall, surgical excision of Morton neuroma can provide effective pain relief and improved function for patients, with both the dorsal and plantar approaches offering successful post-operative results.
