ORTHOPEDICS / FOOT HEALTH
Foot pain may arise from several reasons, but when experiencing a severe and piercing pain that disappear when you stop walking and make massage to your foot, you may have a Morton’s Neuroma.
A Neuroma is an enlargement or a coagulation of a nerve in the foot between the toes, (generally in the third interspace between the third and fourth toes, followed by the second interspace between the second and third toes).
Morton’s Neuromas can seldom affect the fourth and first interspaces.
Morton’s Neuroma may develop at 15% chances in both feet.
Morton’s Neuromas arise most frequently in women who are between 30 to 50 years old, (habitually due to poor-fitting shoes).
Morton’s Neuroma/Causes
A Morton’s neuroma is traditionally thought to be caused by a damage to the nerve.
The damage may be caused by an injury to the metatarsal heads.
These assemblages can cause compression and damage to the nerve, firstly causing inflammation, then over the time, if the compression persists, the nerve repairs itself with fibrous tissue that leads to enlargement and coagulatiion of the nerve.
Other nerve damages reasons may include simply having an incorrect walking style or an awkward foot assembly, such as overpronation (foot rolls inward), hypermobility (too much motion), cavo varus (high arch foot) and extreme dorsiflexion (toes bend upward) of the toes.
These biomechanical factors may cause damage to the nerve with every step.
Morton’s Neuroma / Indications
Primarily, these indications may occur occasionally, but as the disorder gets worse, the signs may occur all of the time.
Some of these signs are:
Pain (sharp, acute, aching, shooting)
Coldness
Stinging or “pins & needles”
Burning
Cramping
A feeling that you are stepping on something or that something is in your shoe
Morton’s Neuroma / Diagnosis
Your foot doctor (podiatrist) will ask many questions about your signs and symptoms and will perform a physical exam accordingly.
One of the exams is called a web space compression test.
This test is done by squeezing the metatarsals (the bones just below the toes) together with one hand and using the thumb and index finger of the other hand to compress the affected zone to reproduce the pain/symptoms.
A Morton’s neuroma is typically diagnosed based on the history and physical exam findings, but sometimes other tests such as an X-ray, ultrasound or an MRI may be needed.
Morton’s Neuroma /Therapy
- Wearing suitable shoes that are wide and deep in the toe box so they do not put pressure on your toes and metatarsals.
- Avoiding wearing high heels because they cause increased pressure on the forefoot.
- Metatarsal pads: These help lifting and separating the metatarsal heads to take pressure off of the nerve.
- Activity alteration: For example, you may try swimming instead of running until your indicators disappear.
- Sticking with athletic tape
- Icing
- (anti-inflammatory medications): Aleve, ibuprofen, etc.
- Arch supports or orthotics: These help to control some of the irregular mobility in your feet. The irregular mobility can lead to extra torque and pressure on the nerve.
- Physical therapy
- Cortisone injection: Helps to decrease the irritated size and distended the nerve.
- Alcohol injection: Helps to end the nerve chemically.
- Surgery: If conservative therapy does not help, surgery may be needed. (Surgery may involve cutting out the nerve or cutting the intermetatarsal ligament).
Morton’s Neuroma / Prevention
Avoid wearing narrow and pointed toe shoes
Avoid wearing high heel shoes
These two instructions are most frequently recommended to alleviate Morton’s Neuroma pain.