Neuromas

Morton's Neuroma: a pain in the foot 

When your feet hurt, you hurt all over. Foot pain affects a person's physical and mental well being. Simply speaking, pain in the feet can be a real pain in the butt. 

Foot pain has a way of nagging away throughout the day. Unfortunately, almost everyone will experience a foot problem at some point in his or her lives. 

A Morton's neuroma is one of the more common problems treated by podiatrists today. It is one of the typical nagging, bothersome foot problems. This foot ailment was first described by the Queen's chiropodist, Louis Durlacher, in 1845. 

This neuroma was later named after T.G. Morton who, incidentally, was from Philadelphia. In addition to Durlacher and Morton, many others have written about this foot neuroma. 

A Morton's neuroma is an irritated, swollen nerve in the ball of the foot, classically described as a pain in the ball of the foot located between the base of the third and fourth toes. The involved nerve lies sometimes squeezed and irritated by these adjacent metatarsal heads causing the painful neuroma to develop. The metatarsal heads are located in the ball of the foot. This area is already subjected to considerable pressures from shoes and walking. 

We now know from experience that a neuroma can also develop between the second and third metatarsals. In fact, a neuroma can develop anywhere there is a nerve. This Morton's neuroma is more commonly a problem in females. High-heeled shoes with cramped pointed tips cause additional pressure and irritation on these nerves in the ball of the foot. 

Individual complaints for a neuroma vary. Frequently, a burning sensation is experienced in the ball of the foot. Patients also complain of cramping in the foot. A sharp pain is sometimes experienced between the bones (metatarsal heads) at the base of the toes. This pain and sometimes a "feeling of numbness" may involve the corresponding toes that the nerve a supplies. 

Walking in shoes aggravates pain. Often a patient will state there is a relief after removing their shoes. Many patients will massage their foot after removing the shoes. Less commonly, a patient describes a sensation of "walking on a pebble" because the inflamed, swollen nerve is felt under the ball of the foot. A neuroma may be the result of an injury to the foot. The traumatic event might just be the result of shoes. Most of the time there is no recollection of any injury. 

A diagnosis of neuroma is based on the symptoms described by the patient and a good clinical exam. Tenderness is reproduced when specific areas of the foot are touched. Sometimes the examiner feels a mass (the neuroma). The clinical exam will rule out other disorders, which may be present with similar symptoms. Stress fractures, metatarsalgia, rheumatoid arthritis, diabetic neuropathy and referred pain from the back are just a few conditions, which cause foot pain. 

Treatment begins with conservative padding and strapping of the foot. Orthotic devices, anti-inflammatories, physical therapy, steroid injections and the changing of shoe types are used in treating Morton's neuroma. 

In chronic cases, surgical excision of the involved nerve mass provides the best relief from this painful condition. Early diagnosis and treatment of the problem will increase the success of conservative care. Neuromas as well as other foot problems can be treated.