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Signs and Symptoms: The pain from a Morton's neuroma is found on the ball of the foot usually between the 3rd and 4th toes to a lesser degree it is some time located between the 2nd and 3rd toes. The quality of the pain ranges from a burning/tingling pain to sharp/radiating pain. Most of the time the pain can be felt in the toes as well as the ball of the foot. Sometime, the pain is worse with walking, when the front of the foot pushes off the ground, and therefore increases pressure on the ball of the foot.
Diagnosis:
1. Physical Exam: The podiatrist will perform a series of test to determine whether the cause of the pain is being caused by a Morton's neuroma. One common exam is called a Mulder's Click. The podiatrist will apply pressure with his/her fingers to the top and bottom of the foot where the pain is found and squeeze the front of the foot at the same time. The podiatrist will be looking for a clicking sensation in the area. Producing this click could cause the irritated nerve to contact the ligament and recreate the symptoms. The term Tinel's Sign is used to describe the sensation of pain that radiates from the sight of the neuroma (in the ball of the foot) toward the toes.
2. Imaging: The podiatrist will request X-rays to rule out other irregularities that may cause pain to the area, such as a stress fracture or a cyst or bone spur. Since these masses are soft tissue an MRI or diagnostic ultrasound maybe utilized to visualize a neuroma.
Conservative Treatment:
1. Anti-inflammatory medicines such as Mortrin can decrease the inflammation caused by nerve irritation and therefore, may decrease symptoms. However, this will only work on the symptoms and will not change the neuroma.
2. Padding may be recommended to relieve the pressure off of the neuroma. There are pads that are places between the bones to separate them in order to stop the neuroma from being compressed. Padding may also be added to a shoe insert at the ball of the foot to relieve pressure as well.
3. Custom shoe inserts (Orthotics) can alleviate the symptoms of a neuroma. The custom shoe inserts can stabilize the bone structures and improve foot function to prevent nerve compression by the ligaments.
4. Shoe gear modification can be helpful in the reducing neuroma pain. Rocker-bottom shoes reduce the flexing of the toes, and thus reduce the degree of pressure to the ball of the foot where the neuroma is located. Avoiding high-heeled shoes and wearing shoes with a wide toe box increases the space for the foot. The decreased external compression from the shoes may help to reduce the pain from the neuroma.
5. Injection therapy with combination of steroids and local anesthetics may be used to relieve the pain and symptoms caused by the neuroma. Since frequent steroid injection may cause damage to the fat pad found on the bottom of the foot, these injections can only be used in limited quantities.
Surgical Treatment:
If the pain from the neuroma is intolerable and the conservative management has failed to help, there are surgical options. There are surgical procedures designed to remove the neuroma and the portion of the nerve that is causing pain. There is also a surgery to sever the ligament that crosses over the nerve. This technique is called nerve decompression. These procedures are performed in an out patient facility so that the patient can return home right after the surgery is finished. Following the surgery there is a chance that the neuroma may grow again. However, studies have shown that this is infrequent and occurs in one percent of patients undergoing neuroma removal. If the there is neuroma regrowth and the pain persists, additional surgery may be needed.
