What is Morton's Neuroma?
Morton's Neuroma, a common foot condition, can cause discomfort and pain in the forefoot area. This condition typically occurs between the third and fourth toes when the tissue surrounding the digital nerve becomes thickened. As podiatrists, we understand the impact Morton's Neuroma can have on your daily life, and in this blog, we'll delve into its diagnosis and various treatment options, ranging from conservative methods to more advanced interventions.
Signs and symptoms
Tingling/numbness/burning sensation: Disconcerting sensations such as tingling, numbness, or an ardently burning quality, prominently localised between the third and fourth digits, characterise Morton's Neuroma.
Phantom pebble signs: An intriguing characteristic involves the illusion of a foreign body, like a pebble, within the shoe. This can be a sign of Morton's Neuroma
Footwear tightness or discomfort: Due to the neuroma's impact on metatarsal alignment, your shoes might feel tighter or uncomfortable.
Pain in between the metatarsals: There might be some pain if you press on the top of your foot, the web in between your toes. This might mean your Morton's Neuroma is companying with metatarsal bursitis. Your podiatrist can diagnose this in the clinic and confirm with ultrasound imaging.
Causes of Morton's Neuroma
Footwear: Wearing shoes with a narrow toe box or high heels can force the toes together, compressing the metatarsal bones and putting pressure on the digital nerves. This chronic irritation can lead to the development of a neuroma.
Foot Biomechanics: Certain foot deformities or irregularities in foot mechanics, such as bunions, hammertoes, flat feet or very high arch feet can create instability in the forefoot. This instability can cause increased pressure on the nerves and contribute to neuroma formation.
Repetitive Stress: Engaging in activities that involve repetitive impact on the forefoot, like running or participating in high-impact sports, can increase the likelihood of nerve irritation and subsequent neuroma development.
Genetics: Some individuals may have a genetic predisposition to developing Morton's Neuroma. Certain foot structures and shapes could inherently put them at a higher risk.
Trauma: Previous foot injuries, such as sprains or fractures, might disrupt the normal alignment of the metatarsal bones, leading to nerve compression and the eventual formation of a neuroma.
Occupational Factors: Professions that require prolonged standing or walking can increase the pressure on the forefoot and contribute to the development of Morton's Neuroma.
Diagnosis of Morton's Neuroma
Diagnosing Morton's Neuroma involves a comprehensive assessment by a skilled podiatrist. Your medical history, lifestyle, and physical examination are crucial components of the diagnostic process. During the examination, the podiatrist will carefully palpate the affected area, looking for signs of tenderness; swelling; numbness, and tingling sensation. To rule out other potential causes, such as stress fractures or arthritis, imaging tests like X-rays or ultrasound scans might be recommended.
Podiatrists also conduct comprehensive biomechanical assessments, providing insights into individual foot mechanics that contribute to the condition. Joint range of motion evaluation uncovers abnormalities in the foot; while standing weight-bearing analysis identifies imbalances like pronation or supination that affect nerve compression. Gait analysis examines walking patterns, revealing issues such as toe gripping or awkward forefoot striking that contribute to nerve irritation. Integrating these assessments aids podiatrists in creating tailored treatment plans.
Conservative Treatment for Morton's Neuroma
Orthotic Support: Custom-made orthotics can be a game-changer for Morton's Neuroma. These specially designed shoe inserts provide arch support, redistributing pressure and relieving strain on the affected nerve. Orthotics also promote proper foot alignment, reducing the risk of further irritation.
Appropriate Footwear: Wearing shoes that fit well is paramount. Opt for wide and well-fitting footwear with ample toe room. This helps prevent compression of the toes and reduces nerve irritation. Avoid high heels and tight shoes that can exacerbate the condition.
Dry Needling: This minimally invasive technique involves inserting fine needles into trigger points in the foot. Dry needling can help release muscle tension and improve blood flow, providing relief from the discomfort associated with Morton's Neuroma.
Mobilisation and Manipulation: Manual therapies performed by a skilled podiatrist can help improve joint mobility and alleviate pressure on the affected nerve. These techniques can include joint mobilisation and manipulation to restore normal foot mechanics.
Advanced Interventions
Cortisone Injection: For cases that don't respond to conservative methods, cortisone injections may be considered. Cortisone is a powerful anti-inflammatory medication that can provide temporary relief by reducing swelling around the affected nerve.
Surgical Procedures: Surgical intervention might be necessary when all else fails. A podiatric surgeon can perform the procedures to remove the thickened tissue or decompress the nerve. Surgical options vary based on the severity of the condition and the patient's unique needs.
Conclusions
Morton's Neuroma, with its potential to disrupt daily activities and quality of life, requires meticulous diagnosis and tailored treatment. Podiatrists are at the forefront of managing this condition, employing a spectrum of interventions ranging from conservative methods to advanced procedures. A multidimensional approach, encompassing orthotic support, suitable footwear, physical therapy, dry needling, cortisone injections, and surgical options, ensures that individuals can navigate their journey toward relief with confidence. If you're grappling with the discomfort of Morton's Neuroma, remember that expert podiatric guidance is instrumental in restoring foot health and overall well-being.