Mortons neuroma it's causes, symptoms and treatment

Medically Reviewed By : Dr Sravya, MBBS, MS

Introduction

There are several believed causing explanations including chronic repeated trauma, entrapment, and intermetatarsal bursitis for the widespread ailment known as Morton’s neuroma, which primarily affects middle-aged women.

Although histological investigation confirms the presence of inflammation in the tissue that is, perineural fibrosis—incorrect terminology suggests that the underlying disease process is a nerve tumor. The third planter is most frequently damaged, along with the common digital nerve and its branches.

Ultrasonography and magnetic resonance imaging may be used to assist in the diagnosis, which is typically determined by the collection of a medical history and clinical examination. Special orthotics, shoe modifications, injections of steroids, sclerosing agents, and local anesthetics are some of the current conservative therapy options. Nerve decompression or neurectomy are the two main surgical therapy options.

It is a distressing foot ailment resulting from the thickening of tissue around one of the nerves that lead to the toes. While not a true neuroma or tumor, this condition stems from repetitive compression or irritation. It commonly affects the area between the third and fourth toes, though other regions may also be impacted. We will explore the causes, symptoms, and a range of possible treatments for it in this detailed guide.

In This Article

Causes of Morton's Neuroma:

The precise cause of Morton’s neuroma isn’t always evident, but several factors can contribute to its development:

Footwear: Tight, narrow shoes or high heels can increase pressure on the forefoot, leading to nerve compression and this is the major cause for morton's neuroma.
Foot Structure: Individuals with certain foot deformities, such as bunions, hammertoes, or flat feet, are more susceptible to developing this disease.
Repetitive Stress: Engaging in high-impact activities or sports that involve repetitive stress on the forefoot can irritate and inflame the nerve and this is the major cause for morton's neuroma.
Foot Trauma: Previous injuries or trauma to the foot can increase the risk of nerve damage and entrapment.

Symptoms of Morton's Neuroma:

It may result in a variety of distressing symptoms, varying in severity from person to person. Common symptoms include:

Pain: A defining sign is a strong, searing sensation in the ball of the foot, usually between the third and fourth toes.
Numbness and Tingling: There may be tingling or numbness in the afflicted area for some people.
Sensation of an Object: Some patients describe feeling as if there is a pebble or small object stuck under the ball of the foot.
Pain Relief with Rest: Pain may subside when the affected foot is not bearing weight or at rest.
Pain Aggravation: Activities that involve standing, walking, or wearing tight shoes can exacerbate the pain.

Diagnosis:

Diagnosing involves a comprehensive examination by a healthcare professional or a podiatrist. The process typically includes:

Radiologically: Large tumors can cause lateral toe deviation on radiographs and can even generate a hazy radiopaque shadow. Computed tomography, nuclear magnetic resonance imaging, or ultrasonography can all show the size and form.
Medical history: The medical professional will go over the patient's medical background, taking into account any foot-related injuries or diseases.
Physical Examination: A thorough examination of the foot to assess for tenderness, swelling, and the presence of a mass or thickening.
Palpation: Gentle pressure is applied to the affected area to elicit pain and help identify the exact location of the neuroma.
Imaging Studies: X-rays, ultrasound, or MRI may be ordered to rule out other conditions and visualize the neuroma more clearly.

It should be diagnosed in the differential with lumbar radiculopathy, tarsal tunnel syndrome, metatarsal stress fractures, painful plantar callosity linked to hammertoes and claw toes, Freiberg’s infraction, peripheral neuritis and neuropathy, intermetatarsal bursitis, rheumatoid arthritis, metatarsal tumors, and soft tissue tumors of the forefoot.

Treatment Options:

Treatment for Morton’s neuroma aims to relieve pain, reduce inflammation, and alleviate pressure on the affected nerve. The severity of the ailment and the patient’s choices influence the therapy option.

1. Conservative treatment:

Footwear Modification: Wearing shoes with a wider toe box and lower heels can decrease pressure on the forefoot and provide relief.
Orthotic Devices: Custom-made shoe inserts or metatarsal pads can help distribute pressure more evenly and reduce nerve compression.
Medications: Over-the-counter pain relievers like ibuprofen or naproxen can be used to manage pain and reduce inflammation.
Corticosteroid Injections:Injecting corticosteroids into the affected area can provide temporary relief by reducing inflammation.
Physical Therapy: Specific exercises can help strengthen foot muscles and improve foot mechanics, reducing pressure on the nerve.
Ice: Applying ice to the sore area might help with swelling reduction and provide temporary numbness.

Before surgery it is advised, frequently uses conservative treatments like low-heeled, wide, and comfortable shoes with large toe boxes, a metatarsal bar, a metatarsal pad, arch support, custom foot orthoses, nonsteroidal anti-inflammatory drugs, and infrequent injections of a corticosteroid and local anesthetic mixture into the involved web space.

Typically, these nonsurgical treatments are kept up for about a year before considering surgical surgery. It is excised as an outpatient procedure by a dorsal incision while an ankle nerve block is applied when surgery is necessary.To establish hemostasis, the ankle is wrapped in a 6-inch elastic bandage.

2. Surgical Treatment:

Neurectomy: In severe cases where conservative treatments fail, surgical removal of the affected nerve (neurectomy) may be recommended. This procedure aims to permanently relieve pain but can result in some permanent numbness in the affected area.
Decompression surgery: This operation includes severing tissues or ligaments close to the nerve to relieve pressure on it.
Nerve Ablation: Some minimally invasive techniques involve using radiofrequency or cryotherapy to ablate or destroy the nerve fibers, reducing pain signals.

Steps:-

A longitudinal skin incision is made over the affected web space, which is commonly the third web space, to start the procedure.
The third interosseous space's dorsal interosseous fascia is longitudinally incised by retracting the intermediate dorsal cutaneous branch of the superficial peroneal nerve's dorsal sensory branch.
To allow for a larger surgical exposure, the third dorsal interosseous muscle is partially separated from the distal end of the fourth metatarsal.
Between the third and fourth metatarsals, a tiny lamina spreader is introduced, and the transverse intermetatarsal ligament is severed.
To make the subsequent proximal transection of the third common digital nerve possible, the adductor muscle's transverse muscular belly is partially cut.
The two appropriate digital nerves of the tumor are softly severed by retracting the lumbrical muscle laterally and the digital artery medially.
The common digital nerve is dissected as proximally as feasible before being sliced to liberate the whole of the tumor.
This is accomplished by securely clamping an Ellis clamp onto the partly detached neuroma. On a regular basis, the skin is closed and a compression dressing is applied.

Recovery and Post-Treatment Care:

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Prevention:

While it may not always be possible to prevent the tumor, certain measures can reduce the risk of developing this condition:

Choosing proper footwear that provides adequate toe space and arch support.
Avoiding high heels or shoes that squeeze the toes together for extended periods.
Retaining a healthy weight to relieve foot discomfort.
Taking regular breaks during high-impact activities or sports to allow the feet to rest.

Conclusion:

It is a painful foot condition brought on by irritation and compression of the nerves. It can cause severe discomfort and impair a person’s ability to move around and carry out regular tasks. Effective symptom management can be achieved with early diagnosis and proper therapy, which can range from non- surgical therapies to surgical operations. If you have recurrent foot pain or believe you may have a tumour, you should see a doctor or podiatrist right once to get a proper diagnosis and individualised treatment.