Neuromas

Morton's Neuroma
When two bones repeatedly rub together, it will usually cause the outer coating of a nerve in your foot to swell which is called a neuroma or a Morton's neuroma. It is most commonly affected between the metatarsal heads of the third and fourth toe.
The pain from the neuroma may start gradually but may become a severe and persistent pain. It is described as a burning, cramping or aching sensation but may cause tingling or numbness. It usually occurs after walking or standing on your feet for a long period of time and is commonly found in people who wear tight-fitting shoes. The pain is usually relieved by removing the shoe and massaging the affected area.

Almost 90% of all Neuromas are found in females between the ages of 18 - 85 years old. Single neuromas are most common, however, instances of multiple neuromas in the same foot have been reported. Morton's Neuroma most often involves the nerve found in the third interspace or the nerve that supplies sensation to the third and forth toes.

Causing Factors
The exact etiology of Morton's Neuroma is still somewhat unclear, however, there are a number of precipitating factors that can cause a localized irritation to the nerve and thus may contribute to the development of a neuroma. These precipitating factors are:

  • Footgear: Any shoe that is high-heeled or is constricting may place the individual at higher risk for developing a neuroma. Morton's Neuroma is commonly found in women who have worn high-heeled shoes for many years or men in an occupation require excessive stress of the forefoot such as kneeling or climbing ladders or are required to wear constricting shoegear.
  • Biomechanical abmormalities: An unstable (pronated) foot can predispose the foot to the development of a neuroma. The excessive pulling on the common digital nerve against the deep transverse intermetatarsal ligament results in irritation and eventually the development of the neuroma.
  • Trauma: Repetitive trauma that results from certain activities such as basketball, tennis, aerobics, running, etc., may precipitate the development of a neuroma. Trauma resulting from an injury such as fractures, sprains, dislocations and crushing injuries may cause a neuroma.

Diagnosing Neuromas
It is wise to consult with your doctor, discuss the pains, your past medical history or any other medical history that could involve nerve problems. Since there is no visible sign of this illness, your doctor will examine your foot carefully, gently pressing the areas around the neuroma to determine the extent of your pain.

  • History: Taking an accurate history is probably the most important component of making an accurate diagnosis of Morton's Neuroma.In most cases the history is consistent in its presentation. This includes pain with walking that may present itself as a burning, shooting, tingling, stabbing and/or radiating in nature. The symptoms are relieved by removing the shoes and massaging the affected area and generally is described as affecting the lateral two or three toes. On occassion the patient may experience a palpation or clicking feeling between the toes.
  • Physical Examination: Often times the symptoms of a neuroma can be reproduced with a careful examination. A painful, palpable, movable mass between the metatarsal heads that reproduces the pain is a strong clinical indicator of a neuroma.
  • Diagnostic Procedures:
    • X-rays of the foot are utilized to rule out bony pathology (such as bone tumors, bone spurs, arthritis etc,.) that may be contributing to the development of a neuroma.
    • MRIs can be helpful in confirming a neuroma. It's use,however, is not recommended as part of the routine workup because of the expense and the diagnosis is quite reliable with the above history and examination.

Courtesy of The Center for Podiatric Information


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