What is "Morton's neuroma" and what is the best way to treat it?
As a runner myself I have suffered from a Morton's neuroma. I have been able to manage my neuroma with basic conservative treatment and continue to run without pain. The key is an accurate diagnosis and prompt treatment. I would like to discuss the etiology of neuromas and the conservative treatment that we find helps to get our runners back on stride.
Most patient's will say that they feel a pain in between the third and fourth toes while wearing shoes. Most symptoms feel like a burning and numbness feeling shooting into the toes. Pain is typically with closed toe narrow toe box shoes and patients typically feel relief by taking off their shoes and rubbing their feet.
These are common symptoms of a condition called Morton's neuroma. A neuroma is a thickening of a nerve, and on the foot this occurs most frequently between the third and fourth metatarsal bones and toes. The nerve coursing between these areas can become inflamed when the metatarsal bones are compressed together such as may occur with tight fitting shoes. It may also be aggravated by overuse micro trauma that occurs in weight-bearing sports and exercise, and by biomechanical asymmetries such as over-pronation of the feet.
The symptoms of a neuroma can include pain on the ball of the foot that may be accompanied by a feeling of "pins and needles" or numbness to the 2nd, 3rd or 4th toes. You can also experience the sensation that your socks are bunching up under your feet.
The initial treatment for a neuroma involves the correction of the causative factors. This can include replacing worn out shoes or purchasing a shoe with a wider toebox to allow more space for the front part of the foot. This applies to your dress or business shoes as well as your athletic shoes. Another form of self treatment involves placing a spacer such as a cotton ball between the affected toes to remove pressure of the nerves. If this is still not effective your podiatrist may recommend a series of injection (NO MORE THAN 3) to help reduce inflammation around the nerve. Other conservative treatment may include the use of metatarsal pads or orthotic devices to control any biomechanical problems such as overpronation. Up to three cortisone injections per year can help to resolve symptoms. Another type of injection is alcohol sclerosing agent that essentially quiet's down the nerve inflammation without the need to surgically excise. Very rarely do we need to surgically excise neuromas from our experience over the years.
Finally, if aggressive conservative treatment does not resolve your symptoms, and the pain is causing a modification of your normal activities, surgery may be recommended to remove the inflamed nerve.
As with any other injury, a careful diagnosis is necessary because other problems such as metatarsal stress fractures and metatarsal bursitis can sometimes mimic the symptoms of Morton's neuroma.
Our practice has both diagnostic ultrasound as well as digital x-rays to help make the most accurate diagnosis.
For more information on neuromas please refer to our video on neuroma treatment.