Morton's neuroma is named after Dr Morton who first described this condition in 1876. It is sometimes called Morton's metatarsalgia or interdigital neuroma. It is a condition that affects one of the common plantar digital nerves that run between the long bones (metatarsals) in the foot. It most commonly affects the nerve between the third and fourth metatarsal bones, causing pain and numbness in the third and fourth toes. It can also affect the nerve between the second and third metatarsal bones, causing symptoms in the second and third toes. Morton's neuroma rarely affects the nerve between the first and second, or between the fourth and fifth, metatarsal bones. It tends to affect only one foot. It is rare to get two neuromas at the same time in the same foot.
Some experts believe that other foot conditions may also be associated with Morton's neuroma. This is because other conditions may cause the metatarsal bones to rub against the nerve in your foot. Foot problems that may increase your risk of developing Morton's neuroma include abnormally positioned toes, high arches, where the arch or instep of your foot is raised more than normal, flat feet, low arches or no arches at all, bunions a bony swelling at the base of the toe. Hammer toe, where the toe is bent at the middle joint. Being active and playing sport can make the painful symptoms of Morton's neuroma worse. In particular, running or sports that involve running, such as racquet sports, can place extra pressure on the nerve in your foot, which can aggravate the problem.
A Morton's neuroma causes a "burning" sharp pain and numbness on the bottom of the foot in the involved area, and this pain and numbness can radiate to the nearby toes. The pain is usually increased by walking or when the ball of the foot is squeezed together and decreased with massaging. It may force a person to stop walking or to limp from the pain.
The most common condition misdiagnosed as Morton's neuroma is metatarsophalangeal (MTP) joint synovitis. When pain occurs in the third interspace, the clinician may misdiagnose the condition as Morton's neuroma instead of MTP synovitis, which may manifest very much like Morton's neuroma. MTP synovitis is distinguished from Morton's neuroma by subtle swelling around the joint, pain localized mainly within the joint, and pain with forced toe flexion. Palpation of the MTP joint is performed best with a pinching maneuver from the dorsal and plantar aspects of the joint to elicit tenderness of the joint. Other conditions often misdiagnosed as Morton's neuroma include the following. Stress fracture of the neck of the metatarsal. Rheumatoid arthritis and other systemic arthritic conditions. Hammertoe. Metatarsalgia (ie, plantar tenderness over the metatarsal head) Less common conditions that have overlapping symptoms with Morton's neuroma include the following. Neoplasms. Metatarsal head osteonecrosis. Freiburg. steochondrosis. Ganglion cysts. Intermetatarsal bursal fluid collections. True neuromas.
Non Surgical Treatment
Common treatments involve wearing different shoes or using arch supports. Resting the foot, massaging the toes and using an ice pack may work for some people. A GP or a podiatrist (foot specialist) may also recommend anti-inflammatory painkillers or a course of steroid injections. Numbing injections, in which alcohol and a local anaesthetic are injected into the affected area of the foot, may also be effective. In extreme cases, when the condition does not respond to treatment, day case surgery may be needed.
If symptoms do not respond to any of the above measures then surgery may be suggested. This involves a short 30 minute operation to either remove tissue to take pressure off the nerve or to remove the nerve causing the pain. The surgery can be done as a day case but it will be two or three weeks before you can be fully active on your feet. There may be some lingering numbness afterwards if the nerve is removed. But surgery is successful in around 80% of cases. There is a small risk of complications such as infection and thickening of the skin on the soles of the feet.