One of the more common painful conditions of the foot and ankle is a Morton’s Neuroma. The nerves that supply the sensation to the lesser toes originate on the bottom of the foot. They travel between the long bones of the foot (metatarsals), and at the head of the metatarsal the nerve will branch into the two adjacent toes. In the area where the nerve is about to divide, a ligament crosses between and is attached to the metatarsal heads; it runs perpendicular to the nerve. With repetitive trauma or irritation in that area, the nerve can become inflamed and enlarged. This enlarged nerve can then become pinched between the metatarsal heads and compressed by the ligament crossing the nerve, leading to pain and discomfort. A Morton’s neuroma usually affects the nerve passing into the 3rd and 4th toes.
Common symptoms associated with Morton’s Neuroma are numbness, burning, tingling or shooting pains into the toes. There can be a feeling of walking on a pebble, or a bunched up sock at the ball of the foot. Some patients can feel or hear a clicking as the nerve rubs over the bones during gait. Runners often will develop symptoms at a certain distance into their run; this often becomes quite predictable: “it always starts three miles into my run.”
Combining the symptoms with a clinical exam usually pinpoints the problem. Other problems in this area of the foot are important to rule out, including stress fracture and plantar plate tear. Palpation of the foot between and just behind the metatarsal heads will elicit pain and often electric shooting into the toes. Squeezing of the forefoot from side to side can reproduce the symptoms as well. Plain x-rays can show if there is any bone involvement that many contribute to the damage to the nerve. Though not highly sensitive for Morton’s Neuroma, ultrasound and MRI may be used or recommended to help in the diagnostic process.
Treatment is always easier and more successful when it is addressed early. Conservative treatments are usually successful in reducing the inflammation to the nerve and eliminating symptoms. These treatments include possible shoe and activity modifications, cortisone injection, padding, orthotics, and physical therapy. If symptoms persist, then cryotherapy or a series of alcohol injections may be recommended by your doctor. This is designed to deaden the nerve and reduce symptoms. Ultimately, if your condition worsens and fails to resolve, surgery may be discussed. Surgery can involve two approaches: first is to consider a nerve decompression, which releases the tight ligament binding the nerve, and second is to excise the enlarged and damaged nerve. This usually causes partial numbness into the affected toes, but most often eliminates the pain.
For more information, please call 661-260-1180.