MORTON’S NEUROMA: SYMPTOMS, CAUSES, TREATMENT

Morton's neuroma is a painful foot condition that mostly impacts the nerve that runs between the third and fourth digits and is found in the ball of the foot.

It is not a tumor, as some may believe, but rather a thickening of the tissue around the affected nerve. The nerve becomes trapped, irritated, and inflamed, causing pain and discomfort^[1]. It triggers a stabbing, burning pain in the ball of the foot that often diverges to the toes.

Similar conditions to Morton neuroma can occur in different locations or on nerves in the foot. The symptoms and treatment options for all types of neuroma are generally identical. The treatment choice depends on the condition’s severity and the individual's specific symptoms and needs.

Other names for Morton neuroma include:

• Morton's metatarsalgia
• Intermetatarsal neuroma
• Intermetatarsal space neuroma
• Plantar Digital Neuroma
• Interdigital neuroma

This article will explore the signs and symptoms, possible causes and risk factors, and treatment options for Morton's neuroma.

Morton's Neuroma Signs and Symptoms

The most common symptom of Morton's neuroma is an intense, burning pain in the ball of the foot^[2]. This pain may also radiate to the toes, causing a tingling or numbing sensation.

Those with Morton neuroma may not realize they have a foot condition until struggling with foot pain for several weeks or months, as there is no other apparent physical indication.

Some people may also experience the feeling of having a pebble in their shoe or the sensation of walking on a fold in their sock. The pain may worsen with activity or when wearing tight shoes.

These symptoms start gradually, initially appearing intermittently with narrow-toed shoes or specific activities. Temporary relief may occur with shoe removal or foot massage. However, symptoms worsen over time, becoming more persistent and intense as the neuroma grows.

If left untreated, the nerve changes become permanent.

What Causes Morton's Neuroma?

The specific cause of Morton's neuroma is not fully understood. Several factors may contribute to its progression. These include:

• Wearing high-heeled shoes or shoes with a narrow-toe box
• Foot deformities, such as bunions or hammertoes
• Flat feet or high arches
• Partaking in highly impactful exercises, such as running or jumping
• Previous foot injuries or trauma
• Certain foot conditions, such as stress fractures or arthritis

When to See a Doctor

If you are having symptoms of Morton's neuroma that have not subsided in a few days, it is vital to visit a doctor for a proper diagnosis and treatment plan. You should also seek medical attention if your symptoms heighten or do not improve with at-home treatments. The sooner you get treatment for Morton's neuroma, the better the prognosis.

How Is Morton's Neuroma Diagnosed?

If you experience symptoms of Morton's neuroma, scheduling an appointment with a doctor for a proper diagnosis is essential.

Your doctor will discuss your symptoms, ask questions, perform a foot examination, and compile a medical history if relevant. It is important to come prepared with as many details as possible about when your symptoms began and whether they improved or not in response to anything (e.g., wearing flat versus heeled shoes).

In some instances, the doctor will need to perform various tests to rule out other conditions. These may involve:

• X-rays to eliminate other issues like stress fractures or arthritis
• Ultrasound imaging to visualize the nerve and surrounding area
• Electromyography test to assess nerve and muscle electrical activity and rule out similar conditions

Treatment Options

Several treatment options are available for Morton's neuroma, depending on the severity of the condition. These include pain management, non-surgical treatments, and surgical intervention.

If detected early on in its progression, it is possible to prevent severe Morton's neuroma with conservative measures. If left too long, the thickened tissue will need to be removed.

When deciding on a treatment plan for Morton's neuroma, several factors must be considered. These include:

• Severity of symptoms
• The underlying causes of the condition
• Previous treatments and their effectiveness
• Possible risks and complications of the treatment
• Recovery time and potential for re-occurrence

Your doctor will work with you to determine the best treatment plan for your case.

Pain Management

Pain management techniques can help alleviate the discomfort associated with Morton's neuroma. These may include^[3]:

• Resting and reducing activities that intensify the pain
• Pressing an ice pack on the affected area to lower inflammation
• Using over-the-counter pain relief, such as ibuprofen or acetaminophen
• Wearing comfortable shoes that protect the feet, with a wide toe box and low heels
• Using shoe inserts or orthotics to provide support and cushioning to the foot

Non-Surgical Treatments

Non-surgical treatments for managing Morton's neuroma pain include:

• Steroid injections: Corticosteroid injections block inflammation and pain in the affected area.
• Custom-Made Shoe inserts: These are personalized inserts made by a specialist that can help redistribute pressure on the foot and alleviate symptoms.
• Extracorporeal Shockwave Therapy: Shockwave therapy involves directing high-intensity sound pressure waves at the neuroma. This procedure potentially speeds healing, boosts metabolism, and improves blood flow to the impacted zone.^[4] More research is needed to confirm its efficacy.
• Sclerosing alcohol injections: These involve injecting a solution of alcohol into the affected area to shrink and scar the tissue around the irritated nerve. This treatment aims to reduce inflammation and pain by causing the fibrous tissue to shrink, potentially alleviating symptoms of Morton's Neuroma^[5]. One study assessing its efficacy in 101 patients reveals a high success rate, relieving 84% of patients.

Some patients also benefit from massage^[6] or foot manipulation therapy.

If the pain does not recede and the fibrous tissue growth around the nerve is too thick, non-surgical ablation or surgical intervention can rectify the problem.

• Radiofrequency ablation: This procedure uses heat generated by radiofrequency energy to destroy the affected nerve tissue, providing long-lasting pain relief.^[7]
• Cryo-ablation: This technique is similar to heat ablation, yet uses a cold probe to destroy the nerve instead.^[8] It minimizes the risks of complications associated with open surgery, such as "stump neuroma."

Surgical Intervention

In severe cases, surgery may relieve the symptoms of Morton's neuroma. The surgery type will depend on the location and severity of the condition. Some surgical options include:

• Decompression surgery: This procedure involves releasing the pressure on the affected nerve by cutting nearby ligaments or tissues.^[9]
• Nerve removal: In some cases, the affected nerve may need to be removed to provide relief.
• Nerve relocation: This surgery involves moving the affected nerve to a different location in the foot to relieve pressure.

After surgery, specialized orthotic shoes are worn, the area is kept padded, and a warm compress is recommended. It can take 2-6 weeks for the area to heal.^[10]

Open surgery for Morton's Neuroma comes with inherent risks and potential complications, including the development of stump neuroma. Stump neuroma is when a nerve ending cut during surgery struggles to heal and grow back, forming a painful bundle of nerve tissue. This can lead to a resurgence of Morton's neuroma and ongoing pain and discomfort in the affected area, sometimes requiring further treatment or intervention.

Other risks and complications of open surgery for Morton's Neuroma may include:

• Infection
• Nerve damage
• Scar tissue formation
• Prolonged recovery time
• Possibility of the neuroma re-occurring in the future

Patients must confer over the potential risks with their healthcare provider before opting for surgical intervention.

How Can Morton's Neuroma Be Prevented?

While there is no guaranteed way to prevent Morton's neuroma, there are measures you can take to decrease your odds of developing the condition. These include:

• Wearing comfortable, properly fitting shoes with a broad toe box and low heels
• Avoiding high-impact activities that put pressure on the feet
• Maintaining a healthy weight to reduce pressure on the feet
• Stretching and strengthening exercises for the feet and toes
• Using shoe inserts or orthotics for added support and cushioning

Latest Advancements and Emerging Therapies

Ongoing research continues exploring alternative treatment options for Morton's Neuroma, aiming to provide additional patient choices.

Some of these alternative options include:

1. Platelet-Rich Plasma (PRP) Injections: Regenerative therapies such as stem cell therapy and PRP are ongoing research areas for treating Morton's neuroma and foot injuries. PRP injections involve using a concentration of platelets obtained from the patient's blood to promote healing and tissue regeneration. PRP injections may have a beneficial effect in reducing pain and improving symptoms in Morton's Neuroma.^[11] However, more research is required to establish its efficacy.
2. Neuromodulation Techniques: Neuromodulation techniques, such as transcutaneous electrical nerve stimulation (TENS), are being explored as a potential option for neuropathic pain management^[12]. This technique involves the application of electrical currents to modify nerve activity and alleviate pain. However, further research is necessary to evaluate their efficacy in treating Morton's Neuroma.
3. Ultrasound Diagnostics: In addition to alternative treatment options, imaging techniques like ultrasound are gaining attention for improved diagnosis and treatment guidance. Ultrasound offers real-time imaging of the concerned area, allowing healthcare providers to visualize the neuroma and guide the administration of treatments, such as injections, with higher precision.^[13]
4. Acupuncture: It is important to note that alternative approaches like acupuncture have been mentioned as potential options for Morton's Neuroma^[14]. However, the evidence supporting the effectiveness of acupuncture for this condition is limited, and more research is needed to determine its actual benefits.

As research into Morton's neuroma continues, advancements in alternative treatments and imaging techniques may offer additional options for patients. Healthcare providers and researchers must conduct further studies to better understand the efficacy and safety of these emerging therapies.

Conclusion

Morton's neuroma is a painful condition that can significantly impact daily activities. However, with proper treatment and management, most people can find relief from their symptoms. If you are suffering from foot pain or discomfort, see a doctor immediately for a proper diagnosis and treatment plan. With the latest advancements in non-surgical treatments and surgical interventions, there are many options available to help you find relief from Morton's neuroma.

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