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What Causes Mortons Neuroma

Overview

MortonMorton's neuroma (also known as Morton neuroma, Morton's metatarsalgia, Morton's neuralgia, plantar neuroma, intermetatarsal neuroma, and interdigital neuroma) is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the second and third intermetatarsal spaces (between 2nd-3rd and 3rd-4th metatarsal heads), which results in the entrapment of the affected nerve. The main symptoms are pain and/or numbness, sometimes relieved by removing footwear.

Causes

Morton's Neuroma is a foot condition caused from an abnormal function of the foot that leads to bones squeezing a nerve usually between the 3rd and 4th metatarsal heads. Symptoms of Morton's Neuroma often occur during or after you have been placing significant pressure on the forefoot area, while walking, standing, jumping, or sprinting. This condition can also be caused by footwear selection. Footwear with pointed toes and/or high heels can often lead to a neuroma. Constricting shoes can pinch the nerve between the toes, causing discomfort and extreme pain.

Symptoms

A Morton's neuroma usually causes burning pain, numbness or tingling at the base of the third, fourth or second toes. Pain also can spread from the ball of the foot out to the tips of the toes. In some cases, there also is the sensation of a lump, a fold of sock or a "hot pebble" between the toes. Typically, the pain of a Morton's neuroma is relieved temporarily by taking off your shoes, flexing your toes and rubbing your feet. Symptoms may be aggravated by standing for prolonged periods or by wearing high heels or shoes with a narrow toe box.

Diagnosis

To confirm the diagnosis, your doctor will examine your feet. He or she will look for areas of tenderness, swelling, calluses, numbness, muscle weakness and limited motion. To check for a Morton's neuroma, your doctor will squeeze the sides of your foot. Squeezing should compress the neuroma and trigger your typical pain. In some cases, your doctor will find numbness in the webbed area between the affected toes. Pain in two or more locations on one foot, such as between both the second and third toes and the third and fourth toes, more likely indicates that the toe joints are inflamed rather than a Morton' neuroma.

Non Surgical Treatment

The most important factor in the treatment of Morton's neuroma is changing footwear. Sometimes a cushioned dome pad can be worn inside the shoe and this helps spread the metatarsal heads and decrease pressure on the nerve. There are other products that can be worn between the toes with certain types of shoes or when the client is barefoot. These toe spacers will help reverse biomechanical patterns that aggravate the nerve compression. Massage can be helpful, but should not be performed with deep pressure between the metatarsal heads. Additional pressure in this region can aggravate the nerve compression and prolong the pathology.interdigital neuroma

Surgical Treatment

Surgery for Morton's neuroma is usually a treatment of last resort. It may be recommended if you have severe pain in your foot or if non-surgical treatments haven't worked. Surgery is usually carried out under local anaesthetic, on an outpatient basis, which means you won't need to stay in hospital overnight. The operation can take up to 30 minutes. The surgeon will make a small incision, either on the top of your foot or on the sole. They may try to increase the space around the nerve (nerve decompression) by removing some of the surrounding tissue, or they may remove the nerve completely (nerve resection). If the nerve is removed, the area between your toes may be permanently numb. After the procedure you'll need to wear a special protective shoe until the affected area has healed sufficiently to wear normal footwear. It can take up to four weeks to make a full recovery. Most people (about 75%) who have surgery to treat Morton's neuroma have positive results and their painful symptoms are relieved.
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