Morton's Neuroma
What is Morton's Neuroma and why does it occur?
Morton’s Neuroma is a swelling of the nerves that travel between the bones of your foot. Compression and tension on the nerves is thought to cause this swelling and trauma. Compression occurs because the nerves live between the metatarsal bones of your foot, where there is not a lot of room to begin with. Any external compression such as tight fitting, narrow toe box shoes can significantly contribute to this problem. Additionally, tension on the nerves occur because they run under a tight ligament between the metatarsal bones. Any hyperextension of the toes such as seen with shoes with any type of high heels causes increased tension on the nerve. This combination of tight toe box shoes with high heels common in many high fashion shoes is a major cause of Morton's neuroma. Morton’s Neuroma most commonly develops between the 2nd and 3rd toes, but can occur between the other toes.
Symptoms:
Patients typically present with a burning pain, numbness or tingling in the ball of the foot that often radiates into the toes. Pain typically worsens with activity (specifically running) or when wearing narrow toe-box shoes. There is usually no visible “lump” in the area of the patient's pain.
Diagnostic Testing
An x-ray is usually ordered to r/o bony pathology. Ultrasound or MRI may also be ordered to further evaluate the soft tissue structures surrounding the nerve.
Treatment Options
Nonoperative treatment is the first-line treatment. Avoiding narrow toe-box shoes, especially high heels, is essential. Custom foot orthotics are also usually recommended and can relieve irritation by lifting and separating the bones compressing the nerve. Patients are usually provided a referral to a Podiatrist to obtain these custom orthotics. Patients who do not wish to obtain custom orthotics can purchase non-custom orthotics online or at their local drug store. Cortisone injections, which have anti-inflammatory properties, may also help reduce symptoms, while NSAID’s such as Advil or Aleve can help if not contraindicated for other medical reasons.
Surgical Treatment
Surgery is usually advised when the above nonoperative treatment options fail to relieve symptoms. Surgery involves resecting a small portion of the neve and releasing the tissue around the nerve. While some numbness can occur between the toes, the tradeoff of decreased burning pain is usually worth it, and the numbness can improve over time.
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Recovery Expectations
After surgery, patients are typically allowed to be fully weight bearing in a stiff soled shoe which is worn for up to three to four weeks. Full recovery usually takes 4 to 6 weeks.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.