Definition
Morton’s Neuroma is a common foot problem associated with pain, swelling and/or inflammation of a nerve, usually at the ball of the foot between the 3rd and 4th toes. Symptoms of this condition include sharp pain, burning, and even lack of sensation in the affected area. Morton’s neuroma may also cause numbness, tingling or cramping in the forefoot.
Cause
Morton’s neuroma is a foot condition caused by an abnormal function of the foot that leads to bones squeezing a nerve usually between the 3rd and 4th metatarsal heads. Symptoms often occur during or after there has been significant pressure on the area like after standing, jumping, running. It can also be caused by wearing shoes that are too tight especially if they are pointy and pressing the ones of the forefoot together.
Treatment
The first step of treatment is to select proper footwear. Footwear with a high and wide toe box is ideal for relieving the pain. Often a metatarsal pad located behind the ball of the foot can help to unload the area and therefore relieve the pain. If the problem persists after addressing these issues then you may need Injection therapy. An injection of local anesthetic to relieve pain and a corticosteroid to reduce inflammation may be administered
Surgical Intervention
If conservative measures fail to relieve symptoms then surgery may be considered. Two surgical procedures are available. The dorsal approach involves making an incision on the top of the foot. This approach permits the patient to walk soon after surgery because the stitches are not on the weight-bearing side of the foot. The podiatrist maneuvers the instruments carefully through many structures and cuts the deep transverse metatarsal ligament, which typically causes most of the nerve compression. This procedure can lead to instability in the forefoot that may require attention in the future.
The second procedure involves a plantar approach, in which the incision is made on the sole of the foot. The patient must use crutches for about 3 weeks and the scar that forms can make walking uncomfortable. The advantage of the plantar approach is that the neuroma can be reached easily and ressected without cutting any structures.
Surgical Complications
The surgical area contains very small blood vessels, nerves, and muscles and complications can occur. Once the neuroma is removed, the empty space may fill with blood, resulting in a painful haematoma. There is a risk for infection, necessitating careful monitoring by the podiatrist and patient.
Recurrence is another possibility. The stump of nerve remaining after resection can begin to grow again. If this occurs, the nerve grows in width and length, creating a burning pain that can be treated by injection or further surgery.
