Morton’s Neuroma: Symptoms, Causes, and Treatment

What is Morton’s Neuroma?

Morton’s neuroma is a painful foot condition caused by a thickening of the tissue around a nerve, usually between the third and fourth toes, although it can also occur between other toes. This thickening, which puts pressure on the nerve, is accompanied by symptoms such as pain, burning sensations, numbness, or the feeling of walking on a pebble. It is often caused by repetitive pressure, friction, or direct injury resulting from ill-fitting footwear or certain activities.

Statistics indicate that Morton’s neuroma is relatively common, particularly in specific demographic groups. Women aged 30 to 50 are more prone to developing this condition due to frequent use of narrow and high-heeled shoes, which increase pressure on the forefoot. Factors such as sports activities involving intense foot usage (e.g., running, football, dancing), structural foot abnormalities (e.g., high arches, flat feet), and certain occupational duties requiring prolonged standing also increase the risk of developing Morton’s neuroma across genders and age groups.

Symptoms of Morton’s Neuroma

The symptoms of Morton’s neuroma arise from nerve compression and irritation, leading to varying degrees of discomfort and pain. The most common symptoms include:

• Pain: Often sudden and may worsen with walking or running. It can be described as sharp or a constant burning sensation.
• Sensation of a foreign object in the shoe: Many patients describe the feeling of walking on a crumpled sock or a small stone. This sensation can cause significant discomfort and interfere with daily activities.
• Numbness, burning, or tingling: These sensations frequently occur in the affected area, particularly between the toes where the neuroma is located. They can also spread to surrounding areas of the foot.

The sensation of pain or discomfort often increases after prolonged activity, which may compel individuals to limit their movement.

Causes of Morton’s Neuroma

The development of Morton’s neuroma is not linked to a single identifiable cause but is usually the result of a combination of several factors, including:

• Wearing inappropriate footwear: High heels or narrow shoes significantly increase pressure on the forefoot, particularly in the area between the toes, where Morton’s neuroma most commonly develops. Prolonged use of such footwear can lead to nerve compression and thickening of the surrounding tissue.
• Repetitive activities: Sports and activities involving frequent running, jumping, or other intensive use of the feet can cause repeated pressure on the forefoot. This constant pressure and friction can irritate the nerves and promote neuroma formation.
• Anatomical foot characteristics: Certain structural abnormalities of the foot, such as high arches, flat feet, or hammer toes, can alter the distribution of weight and pressure on the foot. This can cause increased stress on specific areas, including the region where Morton’s neuroma develops.
• Association with other foot issues: Conditions such as plantar fasciitis (inflammation of the tissue on the bottom of the foot) or bursitis (inflammation of fluid-filled sacs that reduce friction between tissues) can contribute to abnormal foot stresses. This altered dynamics of movement and pressure on the foot may indirectly increase the risk of developing Morton’s neuroma.

Understanding these causes and risk factors is crucial for identifying and reducing the likelihood of developing Morton’s neuroma. Recognizing and adjusting risk factors, such as choosing appropriate footwear and balancing sports and other activities, can play a key role in preventing the onset of this painful condition.

Diagnosis of Morton’s Neuroma

The diagnosis of Morton’s neuroma begins with a detailed assessment of the patient’s symptoms, medical history, and risk factors contributing to the condition. This process requires attentive listening and observation by healthcare professionals to distinguish Morton’s neuroma from other similar foot disorders.

Medical Examination

In addition to a standard consultation and palpation, doctors may perform specific tests to aid in diagnosis:

• Compression Test (Mulder’s Test): During palpation of the affected area, the doctor may feel a characteristic "snap" or click, known as Mulder's click. This occurs when the compressed neuroma moves under pressure, often accompanied by pain or discomfort.
• Gait Test: The doctor may ask the patient to walk barefoot to observe any abnormalities in movement or weight distribution that could contribute to the symptoms.
• Toe Elevation Test: The patient lifts their toes while the doctor observes changes in pain location or pressure sensation, helping to localize the neuroma.
• Tinel’s Sign: This diagnostic technique involves gently tapping along the course of the nerve to determine if it produces radiating pain or tingling into the toes, indicative of nerve irritation or injury.
• Gauthier’s Test: This test involves squeezing the metatarsal bones of the affected toes and moving them upward and downward for about 30 seconds. This specific manipulation can elicit pain or discomfort in the area of the neuroma, indicating its presence.
• Sullivan’s Sign: This sign is observed when, while standing, the affected toes involuntarily splay apart. This visual indicator can assist in identifying Morton’s neuroma, as the spreading of toes suggests structural changes in the foot related to the neuroma.

Imaging Studies

• X-ray: Used to rule out bone abnormalities. In some cases, X-rays may reveal secondary signs of Morton’s neuroma, such as changes in bone structure resulting from prolonged pressure.
• Ultrasound: A relatively accessible and non-invasive method, it provides a good view of soft tissue and is particularly useful in diagnosing Morton’s neuroma.
• MRI (Magnetic Resonance Imaging): Offers precise imaging of soft tissues and is extremely useful in complex cases requiring accurate localization of the neuroma or when ultrasound results are inconclusive.

Accurate diagnosis is the foundation for successfully managing Morton’s neuroma. By utilizing a combination of these tests, along with a thorough medical examination and imaging studies, doctors can precisely identify the neuroma and develop an individualized treatment plan that addresses the specific needs of each patient.

Treatment of Morton’s Neuroma

The treatment of Morton’s neuroma focuses on relieving pain and inflammation while preventing further pressure on the affected nerve. Approaches vary based on the severity of symptoms and their impact on the individual’s daily life.

Conservative Treatment Methods

• Footwear Modification: Opting for shoes with more toe space and a lower heel should be taken seriously, as this simple change can significantly reduce symptoms. For athletes, it is crucial to choose footwear specifically designed for their activity to minimize pressure on the neuroma area.
• Orthotic Inserts and Pads: Custom orthotic inserts or silicone pads placed around the affected area can provide additional support and cushioning during walking.
• Physiotherapy: In addition to stretching exercises and massages, physiotherapy may involve the use of cold compresses or low-frequency sound wave therapy to reduce inflammation and pain.

Medical Treatment Options

• Steroid Injections: These injections are often effective in reducing acute inflammation, although their effectiveness may diminish over time, so they are used judiciously.
• Pain Relief Medications: NSAIDs (Nonsteroidal Anti-Inflammatory Drugs), such as ibuprofen or naproxen, are often prescribed for short-term relief of pain and inflammation.

Surgical Options

• Decompression Surgery: This procedure involves removing or relieving structures around the neuroma to reduce pressure on the nerve.
• Neuroma Excision: In severe cases, when other methods do not provide relief, surgical removal of the affected nerve tissue may be considered. Modern techniques ensure this procedure is relatively minimally invasive with a high success rate.

For those dealing with Morton’s neuroma, it is essential to work closely with healthcare professionals to find the best treatment plan tailored to their needs and lifestyle. Active participation and adherence to therapeutic recommendations are the foundation for successfully managing this condition and maintaining a high quality of life.