Morton’s Neuroma

Dr. Danciger

Morton’s neuroma is actually a “perineural fibrosis.” What this means in English is a chronic scarring around the nerve, causing increased pressure on the nerve. This scarring is similar to an onion-skin formation of scar tissue layered with fluid around a small interdigital nerve. As the fluid increases and scar grows you’ll experience more pain. This is a compression problem. The nerve is squeezed between the scarring the ligaments connecting the metatarsal bones, the long bones behind your toes. Many times bending the toes upwards causes increased pressure on the nerve and ligament, like what occurs wearing high-heeled shoes. If left untreated, the nerve can be permanently damaged.

Any type of compression in the toes can cause a neuroma. Most often, it is a combination of faulty biomechanics along with improper shoes or repetitive stress activities that lead to the formation of a neuroma. Foot deformities such as bunions and hammertoes increase your risk of neuromas. Injuries such as stress fractures and sprains can also lead to the formation of neuromas. Whatever the underlying cause, neuromas usually progress from a minor irritation to a big pain in the foot!

Symptoms of neuromas usually start with an annoying “bunched-up sock” feeling in the ball of your foot.  In the early stages, taking your shoes off can alleviate these early symptoms. However, after some time the pain does not go away.  It can progress to numbness, burning and pain in the ball of the foot, which can radiate into your toes.  This can feel like an electric shock to the toes. Typically and most common, the neuroma will occur between the third and fourth toes, but it can also develop between the second and third toes, especially in patients with other deformities such as bunions. Occasionally, patients can have numerous neuromas in the foot.

Diagnosis is obtained through physical examination, X-rays (to rule out a fracture or other bone abnormality) and ultrasound, which can help identify the neuroma. Magnetic resonance images (MRIs) are usually not taken small enough to see the tiny interdigital neuromas.

Treatment includes changing your footwear; injections of anti-inflammatory medication; padding; functional orthosis to decrease the abnormal biomechanical stress through the foot; and surgery. There are other advances in medicine which may prove helpful in treating neuromas.

If you have treated your problem with conservative therapy without much relief, and you still have pain every day in different types of shoes, it is time to discuss surgery. Surgery should not be the first form of treatment, as most people get relief from non-surgical treatment. There are many new advances in foot surgery and different procedures depending on your activity level, foot type, and the stage of your deformity, your medical history, and your age. Make an appointment if you have progressing symptoms. If conservative treatment fails, surgery can remove the neuroma, allowing you to get back to your normal shoes and activities.

No matter what treatment is rendered, long-term orthotic devices and shoe modification are needed to decrease the chance of recurrence. Seek treatment early to have the best chance of eliminating your pain from the neuroma with conservative treatments.

Dr. Danciger is a podiatrist practicing in Palm Desert.  His practice provides care for infants through geriatric patients, for all foot and ankle problems, including injuries, diseases, medicine and surgery. He is board certified in foot and ankle surgery. Please visit his website at www.CoachellaValleyPodiatrist.com or call him at 760-568-0108.