Morton's Neuroma

Is a painful benign fibrotic enlargement of one of there common digital nerves. It is caused by a shearing force of the adjacent metatarsal bone. It most commonly affects the third common digital nerve. Morton's Neuroma is found to be more common in females. This may be related to the type of shoe gear often worn by females. It is most common in the 4th - 6th decade.


History

Obtaining an accurate history is important to making the diagnosis of Morton's neuroma.

Common Findings

• Pain in the forefoot and corresponding toes adjacent to the neuroma
• Pain is usually described as sharp and burning
• Pain may radiate proximal
• Numbness and tingling often is observed in the toes adjacent to the neuroma
• Intermittent pain
• Massage of the affected area may give some relief
• Narrow tight high-heeled shoes aggravate the symptoms
• Patients may feel as though they are walking on a wrinkle in there sock

Exam

• Firm squeezing of the metatarsal heads with one hand while applying direct pressure to the dorsal and plantar interspace with the other hand may elicit radiating pain.
• Mulder Sign - A silent palpable click produced by the lateral squeeze test. The neuroma moves between the metatarsals.
• Passive and active bending of the toe in an upward direction may aggravate symptoms.
• Sullivan's Sign - Toes adjacent to the affected interspace splay apart on weight bearing.

Imaging

• Ultrasonography
• MRI

Differential Diagnosis

• Stress fracture of the metatarsal
• Rheumatoid arthritis
• Hammertoe
• Metatarsalgia- plantar tenderness over the metatarsal head
• Neoplasms
• Metatarsal head osteonecrosis
• Freiburg osteochondrosis- characterized by interruption of the blood supply of a bone followed by localized bony necrosis.
• Ganglion cysts
• Intermetatarsal bursal fluid collections

Treatment

Treatment strategies for Morton's neuroma range from conservative to surgical management.


Conservative

Bio mechanical

• Orthotics

Medications

• Injections- Corticosteroid- Anti inflammatory agent
• Alcohol sclerosing- Causes a chemical neurolysis of the nerve and used as an alternative to surgery for Morton's neuroma
• NSAID's- Non Steroidal Anti Inflammatory such as Ibuprofen or Naprosyn
• Tricyclic Antidepressants- Amitriptyline(Elavil)
• Anticonvulsants- Neurontin (Gabapentin)
• Pregabalin (Lyrica)
• Duloxetine (Cymbalta)

Rehabilitation Program
Physical Therapy

• Cryotherapy-Cold Therapy- Cold may be applied using an ice bag or a cold pack
• Ultrasonography- Sound waves that are transferred to a specific body area via a round-headed probe. The sound waves travel deep into tissue, creating gentle heat. The heat helps relieve pain and inflammation
• Deep tissue massage
• Stretching exercises
• Phonophoresis- Has been used in an effort to enhance the absorption of topically applied analgesics and anti-inflammatory agents through the therapeutic application of ultrasound

Surgical Intervention

• Neurectomy- When conservative measures for Morton's neuroma are unsuccessful surgical excision may be beneficial

Common Symptoms for Foot Ailments Part 2

Do any of your toenails curl into the fleshy part of your toe causing pain?

You could have an ingrown toenail. This can occur from cutting your toenails rounded at the corners instead of straight across, tight shoes, injuries, toenail fungus, or infections. Do not attempt to cut the toenail out yourself. If you notice your toenail curling even before it is painful call a podiatrist to get this nail removed.

Do you have stinky feet? Do your feet sweat profusely?

You might have Hyperhidrosis or trench foot. This is caused by sweat glands on the bottom of your foot creating more sweat than necessary. What may start off as just an annoyance or unpleasant smell can cause skin to become thick, macerated or painful.

Do you experience a feeling of sharp pain, cramping, or burning in your feet?

You might have a neuroma. A neuroma is when the nerves are pinched by your toe bones. This pinching commonly occurs between the third and forth toes. Tight shoes irritate the symptoms.

Do you have wounds on your feet that do not seem to be healing in a normal amount of time?

You might have chronic wounds or ulcers due to poor circulation or increased pressure on the wound site. These can be very dangerous if they are continuously left untreated. They can become seriously infected or even gangrenous and in severe cases can lead to amputation. Treatment plans can be offered by podiatrists to help the healing process and in most cases can heal in a few months.

Do you have painful growths on the underside of your heel bone? Do the arches of your feet hurt when you get up in the morning?

You might have heel spurs also known as Plantar Fasciitis. This is caused by a strain on the ligaments and muscles attached to your heel bone that lead to the membrane covering the bone to tear. This leaves the ligaments becoming inflamed and the heel bone lacking its natural protective barrier.

If you are experiencing any of these symptoms please call our office and make an appointment today. Don’t live with foot pain any longer! The sooner you get into an office and get your foot pain diagnosed the sooner something can be done about it.