MORTON’S NEUROMA

What’s a Neuroma?

The medical term “Neuroma” refers to the swelling of nerve tissue in the body that can develop anywhere (Matthews, Hurn, Harding, Henry, & Ware, 2019). Morton’s neuroma, or intermetatarsal neuroma, develops between the 3rd and 4th toes of the foot. Between the toes and in the ball of the foot, it causes pain, a burning sensation, tingling, or numbness. “Intermetatarsal” means between the metatarsal bones in the ball of the foot. Neuromas, also known as pinched nerve or nerve tumor, can also develop in other parts of the foot. Compressing and irritating the nerve causes a neuroma to thicken. The nerve enlarges due to this compression, causing Morton’s neuroma symptoms and eventually irreversible nerve damage. 

Although the specific etiology of a neuroma remains unknown, a variety of conditions can contribute to its development (Lin, Hegarty, Fischbein, & Jackler, 2005):

• Neuromas can develop as a result of biomechanical abnormalities such as a high-arched or flat foot. 
• Instability around the toe joints can lead to the development of the condition.
• Nerve injury can occur during inflammation or swelling of the nerve as a result of trauma.
• Improper footwear that squeezes the toes together can cause irritation. Neurosurgeons suggest avoiding shoes with heels higher than two inches. Shoes with this height might put too much pressure on the forefoot.
• Stress can cause or worsen a neuroma.

What’s the Common Signs and Symptoms of a Neuroma?

The most common sign of a neuroma includes pain between the toes. Stopping walking, taking off the shoes, and massaging the affected region might provide comfort against those symptoms. The patient may describe the pain as if he or she went walking about with a stone in his or her shoe. Women account for the greater majority of neuromas compared to men. Morton’s neuroma usually progresses in the following way (Foley et al., 2017):

• The signs and symptoms develop gradually. They start off as a rare occurrence while wearing narrow-toed shoes or engaging in irritating activities.
• By removing the shoe, rubbing the foot, or avoiding irritating shoes or activities, the symptoms may subside momentarily.
• The symptoms will develop over time and may last for many days or weeks.
• As the neuroma grows, the symptoms increase in severity, and the acute abnormalities in the nerve last longer. 

How Do Spinal Specialists Diagnose Neuroma?

The neurosurgeon will take a detailed history of the patient’s symptoms and examine the foot to make a diagnosis. During examination, neurosurgeons will push on the foot to feel for a lump or painful place. They may also hear a “clicking” sensation between the foot’s bones. Later, neurosurgeons will conduct other testing or imaging investigations for accurate diagnosis. Patients need to consult with their neurosurgeons early in the development of symptoms. Early detection of a Morton’s neuroma can help patients avoid surgery and reduce the need for more invasive treatments. Some imaging tests to diagnose Morton’s neuroma may include (Gougoulias, Lampridis, & Sakellariou, 2019):

• MRI: Neurosurgeons use radio waves and magnetic fields to visualize soft tissue abnormalities to detect neuromas.
• X-rays: This helps to see any abnormalities or fractures within the foot.
• Ultrasound: Neurosurgeons use sound waves to create real-time images of internal structures and reveal any tissue abnormalities such as neuromas. 

How Do Spinal Specialists Treat a Neuroma?

Treatment procedures for a neuroma vary depending on the severity of each case, and early detection of the neuroma helps to avoid surgical correction. For example, a pair of thick-soled shoes with a large toe box will typically ease symptoms of undeveloped neuromas, enabling the problem to fade on its own. Therefore, severe cases require additional surgery or treatment to remove the tumor. After a brief examination, spinal specialists will suggest the best treatment option for the patient. These might include (Schoemaker et al., 2005):

• Padding: This supports the metatarsal arch and lessens the pressure on the nerve and decreases the compression while walking.
• Icepack: Placing an ice pack over the affected area can reduce the swelling on the foot. 
• Orthotics: Customized shoes help to control the function of the foot and reduce the symptoms of neuromas.
• Medication: Neurosurgeon administered nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and cortisone injections can relieve acute pain and inflammation caused by the neuroma.

When the above treatment fails, neurosurgeons recommend surgical options such as podiatric decompression surgery to recover from the condition. This surgery helps to remove the inflamed and enlarged nerve and the recovery time lasts a few weeks. Neurosurgeons also suggest modifying activities that repetitively pressurize the neuroma. To prevent neuroma, peoples can follow the below steps:

• Avoid wearing shoes with a tight toe box or a high heel height for lengthy periods of time (greater than two inches).
• Make sure your workout shoes have enough room in the front to avoid excessive toe squash and use a cushion in the ball of the foot inside of the shoe. 

If You need of a Fort Worth Neurosurgeon, Contact Longhorn Brain & Spine Immediately To Get a Consultation.

References

Foley, R. W., Shirazi, S., Maweni, R. M., Walsh, K., McConn Walsh, R., Javadpour, M., & Rawluk, D. (2017). Signs and Symptoms of Acoustic Neuroma at Initial Presentation: An Exploratory Analysis. Cureus, 9(11). https://doi.org/10.7759/cureus.1846

Gougoulias, N., Lampridis, V., & Sakellariou, A. (2019). Morton’s interdigital neuroma: Instructional review. EFORT Open Reviews, 4(1), 14–24. https://doi.org/10.1302/2058-5241.4.180025

Lin, D., Hegarty, J. L., Fischbein, N. J., & Jackler, R. K. (2005). The prevalence of “incidental” acoustic neuroma. Archives of Otolaryngology – Head and Neck Surgery, 131(3), 241–244. https://doi.org/10.1001/archotol.131.3.241

Matthews, B. G., Hurn, S. E., Harding, M. P., Henry, R. A., & Ware, R. S. (2019). The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Morton’s neuroma): A systematic review and meta-analysis. Journal of Foot and Ankle Research, 12(1), 1–21. https://doi.org/10.1186/s13047-019-0320-7

Schoemaker, M. J., Swerdlow, A. J., Ahlbom, A., Auvinen, A., Blaasaas, K. G., Cardis, E., … Tynes, T. (2005). Mobile phone use and risk of acoustic neuroma: Results of the Interphone case-control study in five North European countries. British Journal of Cancer, 93(7), 842–848. https://doi.org/10.1038/sj.bjc.6602764