Interdigital neuroma more commonly known as Mortons neuroma is an entrapment of a nerve that passes into the toes of the foot. The nerve gets entrapped or "pinched" by the metatarsal bones, which are the bones just behind the toes. Typically this type of foot pain is the result of wearing shoes that are too narrow or in the case of women, high heel shoes. Other factors that will cause this condition can be the specific architecture of a person's foot structure as well as occupational hazards such as those who work low to the ground forcing them to kneel down for long periods. An example would be someone who spends long hours planting flowers in a garden; the ball of the foot is being constantly overstretched.
This condition can be very painful. Typically, a person will be walking in shoes (although the condition can be painful out of shoes as well), and will develop a sharp pain just behind the third and fourth toes.
This pain may then radiate into the toes and manifest itself as overt pain, numbness, tingling or burning. This is the most common location for Mortons neuroma, but this condition can also affect the other toes as well. On occasion this pain may also travel backwards further into the foot. Many people will relate that they can feel a "clicking" in the affected area. This is actually the nerve moving up and down between the pressures of the adjacent metatarsal bones. People find that if they remove their shoes and rub the area for a couple of minutes, the pain will subside, only to return once they start walking again.
There are a number of treatments for this condition depending on the severity. Sometimes, just identifying the certain pair of shoes that sets off the pain and no longer wearing them will eradicate the problem.
Anti-inflammatory medication can be helpful, but this should be considered temporary relief and should not be considered for long-term treatment, as there are potential systemic problems with taking this type of medication for long periods of time.
A foot specialist (podiatrist) may recommend an orthotic device, which is a sophisticated arch support, custom made to the foot structure of the patient's foot. The purpose of which is to control the abnormal structural components of the foot, which is contributing to the condition. Many times a neuroma spacer pad can be build into the orthotic which then attempts to spread apart the adjacent metatarsal bones and thereby remove the pressure on the nerve, thus reducing pain. I generally reserve this type of treatment for patients who are not candidates for other types of treatment as I consider it a "stop gap" measure.
Injection of the area can also be very helpful. Some doctors will inject cortisone in an effort to reduce inflammation of the nerve. Others may recommend injecting denatured alcohol, which attempts to sclerose, or deaden the nerve. Both can be very effective. My preferred treatment is multiple injections of denatured alcohol. Any where from one to seven injections repeated on a weekly basis are necessary. I have found the success rate to be in the 80-85 percent range.
When all else fails, surgical excision is usually recommended. This is an out patient procedure where the entrapped nerve is removed. As with any surgery there are potential complications and your doctor should explain these to you. The two biggest complications are misdiagnosis of the neuroma, the nerve is removed and the patient still has pain. The second, more common complication is not resecting enough of the nerve and being left with what we call a stump neuroma. These can be particularly painful and frustrating for the patient.
Morton neuroma, or interdigital neuroma, is a common condition that involves enlargement of the interdigital nerve of the foot. It is associated with pain, swelling and/or an inflammation of a nerve, usually at the ball-of-the-foot between the 3rd and 4th toes. Morton neuroma most commonly affects the third intermetatarsal space, but it can also affect the second intermetatarsal space, although it does so less often. It usually in response to irritation, trauma or excessive pressure. The incidence of Morton's neuroma is 8 to 10 times greater in women than in men. Morton's Neuroma is a foot condition caused from an abnormal function of the foot that leads to bones squeezing a nerve usually between the 3rd and 4th metatarsal heads.
Compression or irritation of the nerve can lead to the development of a neuroma. Symptoms of Morton's Neuroma often occur during or after you have been placing significant pressure on the forefoot area, while walking, standing, jumping, or sprinting. This condition can also be caused by footwear selection. People with certain foot deformities�"bunions, hammertoes, flatfeet, or more flexible feet�"are at higher risk for developing a neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or racquet sports. An injury or other type of trauma to the area may also lead to a neuroma. Highest prevalence of Morton's neuroma is found in patients aged 15-50 years, but the condition may occur in any ambulatory patient.
Many/most patients with MN can be successfully treated with a combination of altered shoe wear, insert therapy, and cortisone injections. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Steroids are medications that reduce inflammation. An injection of a corticosteroid medication in the area of the neuroma may reduce pain. In some cases, surgery may be needed to remove the thickened tissue. This can help relieve pain and improve foot function. Wear supportive shoes to help ease Morton’s Neuroma pain. Wear metatarsal pads that help separate the foot bones and relieve pressure on the pinched nerve to ease Morton’s Neuroma pain. Use supportive insoles in your shoes to help treat the pain of Morton’s Neuroma.
Morton's Neuroma Treatment and Prevention Tips
1. Massage also help relieve Morton’s Neuroma pain.
2. Wear metatarsal pads that help separate the foot bones.
3. Use supportive insoles in your shoes to help treat the pain of Morton’s Neuroma.
4. Wear supportive shoes to help ease Morton’s Neuroma pain.
5. Avoid ill-fitting shoes. Wear shoes with a wide toe box.
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