What is it?
Morton’s neuroma is characterized by the thickening of nerve tissue, usually between the third and fourth toes, causing pain. While neuromas, or thickened nerve tissue, may develop elsewhere as well, Morton’s neuroma is the most common type. This condition is caused by compression and irritation of the nerve, resulting in enlargement of the nerve tissue and, eventually, in potentially permanent nerve damage.
What causes Morton’s neuroma?
This condition results from compression and irritation of the nerve running typically between the third and fourth toes, and is often related to a person’s footwear. While both, men and women can develop Morton’s neuroma, it is most frequently seen in women due to the frequent use of high-heeled or tapered toe shoes. The condition may also result from repetitive or high-impact sports, such as running, or those that involve tight-fitting shoes that apply pressure to the toes, like skiing. Wearing shoes that do not fit well can also increase the likelihood of developing Morton’s neuroma.
Trauma to the foot may also result in the development of Morton’s neuroma. Other foot conditions, such as high arches, flat feet, hammertoes, or bunions, may also increase the likelihood of developing Morton’s neuroma.
What are the symptoms?
Common symptoms of Morton’s neuroma include:
- Burning pain in the ball of the foot, spreading to the toes
- Numbness or tingling in the toes
- A sensation described as having a pebble in your shoe
- Symptoms will worsen with wearing high-heeled or poorly fitting shoes as well as with prolonged walking
- Progressively worsening symptoms that last for increasingly long periods of time
How is the condition diagnosed?
Your physician will perform a physical examination of your foot, assessing for any abnormalities or areas of tenderness. Diagnostic imaging may also be used in your diagnosis; X-rays can help rule out other possible diagnoses (such as arthritis or stress fractures), while ultrasound and MRI results are able to reveal any soft tissue irregularities, like a neuroma.
Treatment options:
The treatment options available to you will be dependent on the severity of your condition. Initially, conservative options will be recommended for management of Morton’s neuroma that is in the mild or moderate stage. These options include:
- Rest. Reducing or avoiding activities that increase pressure on your toes may provide relief.
- Change shoes. Avoiding tight, ill-fitting, pointy-toed, or high-heeled shoes will decrease pressure on the toes, thereby reducing irritation and compression of the nerves.
- Orthotics or shoe inserts. Wearing shoes with arch support, foot pads, or custom orthotics will improve the ergonomics of your foot and reduce irritation and of the nerves.
- Ice. Icing the affected foot for 10-15 minutes at a time may provide relief by decreasing inflammation.
- Massage. Massaging the affected area may also provide relief from discomfort.
- Medication. Anti-inflammatory medications can aide in reducing pain and decreasing swelling; however, over-use of medication can have serious adverse side effects.
If conservative treatments are not effective in managing your pain, other non-surgical options may be recommended, including various types of injections, rehabilitation treatments, or medical devices.
The Wilderman Medical Clinic offers the following treatment options for Morton’s neuroma:
Radiofrequency ablation treatment – RFA treatment is a minimally invasive, nonsurgical procedure that uses an ultrasound-guided needle to apply heat to the affected nerve; the heat destroys nerve tissue and, therefore, blocks transmission of pain signals to the brain. While this treatment is not permanent, it provides long-lasting relief from pain for most patients, making it an excellent alternative to surgery. A recent medical study found RFA treatment to successfully relieve pain symptoms in 85% of study participants (https://pubmed.ncbi.nlm.nih.gov/23073898/).
Ultrasound guided injections with cortisone – Cortisone injections are highly effective in providing temporary relief from pain for Morton’s neuroma if symptoms are not responding to conservative treatments; however, it is important to remember that these injections are not a permanent solution, and typically provide relief from symptoms for 1-3 months at a time. Corticosteroids work by reducing swelling in the affected area, thereby alleviating pain. Using ultrasound guided injections increases the accuracy of the procedure, which decreases risk of side effects and possible complications.
Dilute alcohol injections – Morton’s neuroma has been shown to be treated with a fair amount of success using dilute alcohol injections; a recent study in the Journal of the American Podiatric Medical Association found that the treatment alleviated symptoms in 61% of patients studied (https://pubmed.ncbi.nlm.nih.gov/17507528/). The procedure requires repeated injections of a dilute alcohol solution (typically 4-5 injections), which causes damage to the affected nerve tissue, thus inhibiting transmission of pain signals.
Botox injections – Patients who have not responded adequately to conservative treatment may opt for Botox injections to treat their pain; this treatment has been found to be well tolerated and significantly effective in relieving pain and improving function for up to three months at a time.
Prolotherapy injections – Prolotherapy involves injection of an irritant solution into the affected area, which stimulates the body’s natural healing processes. While the regenerative injection treatment has been primarily shown to be effective in treating other musculoskeletal conditions, such as osteoarthritis of the knee, it has had some success in providing relief for patients with Morton’s neuroma. As the procedure is considered very safe, with minimal possible side effects, it may be a viable treatment option.
Assistive devices such as TENS – Transcutaneous electrical nerve stimulation (or TENS) has been reported by patients to provide some relief from pain. The device has electrodes that can be placed near the affected area; electrical impulses are delivered via the electrodes, and can provide a soothing sensation and some decrease in the experience of pain sensation.
Other treatments recommended by our clinic:
Physiotherapy – Physiotherapy sessions can be used to strengthen the muscles of the foot and improve body alignment and gait in order to decrease pressure on the affected nerve tissue, resulting in reduced pain.
Acupuncture – Acupuncture is a holistic technique that uses fine needles inserted at specific sites in order to improve the flow of energy in your body; the treatments are intended to reduce inflammation and promote healing in the treated area.
Chiropractic – Chiropractic adjustments to the bones of the foot may alleviate pressure on the compressed nerve, providing some measure of relief. Adjustments to the spine may also be helpful, as improved posture may reduce pressure on the toes, thereby reducing irritation of the affected nerve.
When to consider surgery:
If your condition is not responding adequately to conservative treatments, physiotherapy, injection therapy, or other non-surgical options, you may need to consider surgical intervention.
Works Cited:
https://www.foothealthfacts.org/conditions/morton-s-neuroma-(intermetatarsal-neuroma)
https://orthoinfo.aaos.org/en/diseases–conditions/mortons-neuroma
https://pubmed.ncbi.nlm.nih.gov/17507528/
https://pubmed.ncbi.nlm.nih.gov/23073898/
https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=zx3505