Morton’s Neuroma (Intermetatarsal
Neuroma)
What Is a
Neuroma?
A neuroma is a thickening of nerve tissue that may develop in various parts
of the body. The most common neuroma in the foot is a Morton’s neuroma, which
occurs between the third and fourth toes. It is sometimes referred to as an
intermetatarsal neuroma. “Intermetatarsal” describes its location in the ball
of the foot between the metatarsal bones. Neuromas may also occur in other
locations in the foot.
![Morton]()
The
thickening, or enlargement, of the nerve that defines a neuroma is the result
of compression and irritation of the nerve. This compression creates
enlargement of the nerve, eventually leading to permanent nerve damage.
Causes
Anything that causes compression or irritation of the nerve can lead to the
development of a neuroma. One of the most common offenders is wearing shoes
that have a tapered toe box, or high-heeled shoes that cause the toes to be
forced into the toe box.
People with certain foot deformities – bunions, hammertoes,
flatfeet, or more flexible feet – are at higher risk for developing a neuroma.
Other potential causes are activities that involve repetitive irritation to the
ball of the foot, such as running or court sports. An injury or other type of
trauma to the area may also lead to a neuroma.
Symptoms
If you have a Morton’s neuroma, you may have one or more of these symptoms
where the nerve damage is occurring:
- Tingling,
burning, or numbness
- Pain
- A
feeling that something is inside the ball of the foot
- A
feeling that there’s something in the shoe or a sock is bunched up
The progression of a Morton’s neuroma often follows this
pattern:
- The
symptoms begin gradually. At first they occur only occasionally, when
wearing narrow-toed shoes or performing certain aggravating activities.
- The
symptoms may go away temporarily by removing the shoe, massaging the foot,
or by avoiding aggravating shoes or activities.
- Over
time the symptoms progressively worsen and may persist for several days or
weeks.
- The
symptoms become more intense as the neuroma enlarges and the temporary
changes in the nerve become permanent.
Diagnosis
To arrive at a diagnosis, the foot and ankle surgeon will obtain a thorough
history of your symptoms and examine your foot. During the physical
examination, the doctor attempts to reproduce your symptoms by manipulating
your foot. Other tests or imaging studies may be performed.
The best time to see your foot and ankle surgeon is early in
the development of symptoms. Early diagnosis of a Morton’s neuroma greatly
lessens the need for more invasive treatments and may avoid surgery.
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. Padding
techniques provide support for the metatarsal arch, thereby lessening the
pressure on the nerve and decreasing the compression when walking.
- Icing. Placing
an icepack on the affected area helps reduce swelling.
- Orthotic
devices. Custom orthotic devices provided by your foot and
ankle surgeon provide the support needed to reduce pressure and
compression on the nerve.
- Activity
modifications. Activities that put repetitive pressure on the
neuroma should be avoided until the condition improves.
- Shoe
modifications. Wear shoes with a wide toe box and avoid
narrow-toed shoes or shoes with high heels.
- Medications. Oral
nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be
recommended to reduce pain and inflammation.
- Injection
therapy. Treatment may include injections of cortisone, local
anesthetics or other agents.
When Is
Surgery Needed?
Surgery may be considered in patients who have not responded adequately to
non-surgical treatments. Your foot and ankle surgeon will determine the
approach that is best for your condition. The length of the recovery period
will vary, depending on the procedure performed.
Regardless of whether you’ve undergone surgical or
nonsurgical treatment, your surgeon will recommend long-term measures to help
keep your symptoms from returning. These include appropriate footwear and
modification of activities to reduce the repetitive pressure on the foot.
Information provided by The American College of Foot and Ankle Surgeons