Morton's Neuroma is a common problem in runners, and there are a number of simple fixes you can try before resorting more drastic solutions like sclerosing or surgery. A Morton's Neuroma normally causes a burning pain in the forefoot, just behind the 3rd and 4th toes (sometimes behind the 2nd and 3rd toes). The pain often radiates towards the toes, and sometimes there is numbness rather than pain. The underlying cause is inflammation of the nerve between the bones of the forefoot, often triggered by narrow or tight shoes. I have had good results with the simple fixes described below, and I have had reports of other runners with similar success.
There are orthoses and corrective shoes that can effectively alleviate disturbances to foot mechanics. A podiatric physician can prescribe the best corrective footwear and shoe inserts for all activities, work, exercise, play, walking, shopping and more, based on an analysis of the patient?s foot and his or her lifestyle. Improper footwear. Podiatric physicians have long believed that constricting, narrow, poor-fitting shoes with a tight or pointed toe box tend to compress the end of the foot, leading to abnormal motion of the foot and to excessive pressure in the area of the nerve. High-heeled shoes are a particular culprit here, since they put pressure on the area around wearer?s toes and the ball of the foot.
Episodes of pain are intermittent. Patients may experience 2 attacks in a week and then none for a year. Recurrences are variable and tend to become more frequent. Between attacks, no symptoms or physical signs occur. Two neuromas coexist on the same foot about 2-3% of the time. Other diagnoses should be considered when 2 or more areas of tenderness are present.
Your health care provider can usually diagnose this problem by examining your foot. A foot x-ray may be done to rule out bone problems. MRI or ultrasound can successfully diagnose the condition. Nerve testing (electromyography) cannot diagnose Morton neuroma. But it may be used to rule out conditions that cause similar symptoms. Blood tests may be done to check for inflammation-related conditions, including certain forms of arthritis.
Non Surgical Treatment
In developing a treatment plan, your foot and ankle surgeon will first determine how long you?ve had the neuroma and evaluate its stage of development. Treatment approaches vary according to the severity of the problem. For mild to moderate neuromas, treatment options may include Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking. Placing an icepack on the affected area helps reduce swelling. Custom orthotic devices provided by your foot and ankle surgeon provide the support needed to reduce pressure and compression on the nerve. Activities that put repetitive pressure on the neuroma should be avoided until the condition improves. Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. Treatment may include injections of cortisone, local anesthetics or other agents.
The ultimate success of a Morton?s neuroma treated surgically can be variable. In cases where the underlying problem is only an irritated nerve (a true Morton?s neuroma), then surgery will probably be curative (although it may take a few months for the foot to fully heal). But in many cases, forefoot pain is more complex. There may be an irritated nerve or two causing pain, but the real problem is often excessive loading of the lesser metatarsals. The generic term for this condition is metatarsalgia. When considering surgery, identifying and addressing these problems may lead to a better end result.