Morton neuromas are focal areas of symptomatic perineural fibrosis around a plantar digital nerve of the foot. The abnormality is non-neoplastic and does not represent a true neuroma. It may more correctly be known as Morton?s metatarsalgia. The condition is thought to be due to chronic entrapment of the nerve by the intermetatarsal ligament. It most often occurs in middle-aged individuals and is many times more common in women than men. Approximately 30% of asymptomatic middle-aged persons have the radiological pathologic findings of a Morton?s neuroma.
The cause of this problem is often due to impingement of the plantar nerve fibres between the metatarsal heads and the intermetatarsal ligament. It is entirely a biomechanical phenomenon. Differential diagnoses include stress fracture, capsulitis, bursitis or ligament injury at the metatarsal-phalangeal joint, a tendon sheath ganglion, foreign-body reaction and nerve-sheath tumour.
Many patients describe the sensation as a burning pain in the ball of the foot that often radiates to the toes. Initially, the pain may become much more apparent when the person wears tight, narrow or high-heeled shoes, or engages in activities which place pressure on the foot. Eventually, symptoms may be continuous and last for days, and even weeks. MRI (magnetic resonance imaging) scans have revealed Morton's neuroma lesions in patients who had no symptoms at all. Symptoms can become so disrupting that many affected individuals become anxious about walking, or even placing their foot on the ground.
Diagnosis of Morton?s Neuroma typically involves a physical examination of the affected foot. Your health care provider will ask you about your symptoms and examine your feet and toes. He will manipulate your toes, pushing them from side to side and squeezing on the spaces in between. This physical exam will allow your health care provider to feel for any lumps that may be present under the soft tissue of your feet. Your health care provider may also listen for any clicking sounds that your bones may be making. Known as Muldor?s Sign, this clicking is common amongst sufferers of foot neuroma. Occasionally, an x-ray or MRI (magnetic resonance imaging) is performed to help rule out any breaks, sprains, or fractures in your foot.
Non Surgical Treatment
Treatment depends on the severity of your symptoms. Your doctor will likely recommend trying conservative approaches first. Arch supports and foot pads fit inside your shoe and help reduce pressure on the nerve. These can be purchased over-the-counter, or your doctor may prescribe a custom-made, individually designed shoe insert, molded to fit the exact contours of your foot.
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.