What Causes Mortons Neuroma

Overview

Morton neuromaMorton’s Neuroma is the most common neuroma in the foot. It occurs in the forefoot area (the ball of the foot) at the base of the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma. “Intermetatarsal” describes its location in the ball of the foot between the metatarsal bones (the bones extending from the toes to the midfoot). A neuroma is a thickening, or enlargement, of the nerve as a result of compression or irritation of the nerve. Compression and irritation creates swelling of the nerve, which can eventually lead to permanent nerve damage.

Causes

Inappropriate footwear is one of the principle causes of Morton?s neuroma. Toe spring and tapering toe boxes are the most problematic shoe design features that contribute to this health problem. Morton?s neuroma occurs when one of your nerves is stretched and pinched, which happens with great frequency in people who wear shoes incorporating these design features. A professional shoe fitting should always be sought if you are struggling with neuroma-related symptoms.

Symptoms

Symptoms associated with a neuroma include a dull burning sensation radiating towards the toes, a cramping feeling, or even a stinging, tingling sensation that can be described as being similar to an electric shock. It is often worse when wearing shoes with most people finding the pain disappears when removing their shoes.

Diagnosis

You should visit a doctor or podiatrist (foot doctor) if you have pain or tingling that does not stop. Your health care provider will examine your feet and will apply pressure on the spaces between the bones of the toes to determine the location of the foot pain. The doctor may order X-rays to rule out other conditions associated with foot pain, such as a stress fracture or arthritis. X-rays alone will not show whether or not a neuroma is present, so an ultrasound scan or magnetic resonance imaging (MRI) test may be done to confirm the diagnosis. A diagnostic procedure called an electromyography is sometimes used to rule out nerve conditions that may cause symptoms like those of associated with Morton?s neuroma.

Non Surgical Treatment

Initial treatment for Morton?s Neuroma may include non-prescription anti-inflammatory medications to reduce pain and swelling. These may consist of standard analgesics such as aspirin and ibuprofen (Advil, Motrin, others). Massaging the painful region three times daily with ice. Change of footwear. Avoid tight shoes, high heels or any footwear that seems to irritate the condition. Low heeled shoes with softer soles are preferable. Arch supports and foot pads to help reduce pressure on the nerve. In some cases, a physician may prescribe a customized shoe insert, molded to fit the contours of the patient?s foot. Reducing activities causing stress to the foot, including jogging, dancing, aerobic activity or any high impact movements of the foot. Injections of a corticosteroid medication to reduce the swelling and inflammation of the nerve and reduce pain. Occasionally other substances may be injected in order to ?ablate? the Neuroma. (The overuse of injected steroids is to be avoided however, as side effects, including weight gain and high blood pressure can result.)

Surgical Treatment

Patients are commonly offered surgery known as neurectomy, which involves removing the affected piece of nerve tissue. Postoperative scar tissue formation (known as stump neuroma) can occur in approximately 20%-30% of cases, causing a return of neuroma symptoms. Neurectomy can be performed using one of two general methods. Making the incision from the dorsal side (the top of the foot) is the more common method but requires cutting the deep transverse metatarsal ligament that connects the 3rd and 4th metatarsals in order to access the nerve beneath it. This results in exaggerated postoperative splaying of the 3rd and 4th digits (toes) due to the loss of the supporting ligamentous structure. This has aesthetic concerns for some patients and possible though unquantified long-term implications for foot structure and health. Alternatively, making the incision from the ventral side (the sole of the foot) allows more direct access to the affected nerve without cutting other structures. However, this approach requires a greater post-operative recovery time where the patient must avoid weight bearing on the affected foot because the ventral aspect of the foot is more highly enervated and impacted by pressure when standing. It also has an increased risk that scar tissue will form in a location that causes ongoing pain.

Prevention

To help reduce your chance of developing Morton’s neuroma avoid wearing tight and/or high-heeled shoes. Maintain or achieve ideal body weight. If you play sports, wear roomy, properly fitting athletic footwear.

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Non Surgical Hammer Toe Treatments

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Hammer ToeOverview

A Hammer toes is a term used to describe a crooked, deviated, or contracted toe. Although the condition usually stems from muscle imbalance, it is often aggravated by poor-fitting shoes or socks that cramp the toes. Over a period of years, the tendons that move the toe up and down begin to pull the toe with unequal tension, and the toe then begins to buckle or become contracted, causing an abnormal ?v?-shaped bending of the little toes. Patients with this condition often experience pain, swelling, redness and stiffness in the affected toes.

Causes

Medical problems, such as stroke or diabetes that affect the nerves, may also lead to hammertoe. For example, diabetes can result in poor circulation, especially in the feet. As a result, the person may not feel that their toes are bent into unnatural positions. The likelihood of developing hammertoe increases with age and may be affected by gender (more common in women) and toe length; for example, when the second toe is longer than the big toe, hammertoe is more likely to occur. Hammertoe may also be present at birth. Genetics may factor in to developing hammertoe, particularly if the foot is flat or has a high arch, resulting in instability.

Hammer ToeSymptoms

People Hammer toes who have painful hammertoes visit their podiatrist because their affected toe is either rubbing on the end their shoe (signaling a contracted flexor tendon), rubbing on the top of their shoe (signaling a contracted extensor tendon), or rubbing on another toe and causing a painful buildup of thick skin, known as a corn.

Diagnosis

Your healthcare provider will examine your foot, checking for redness, swelling, corns, and calluses. Your provider will also measure the flexibility of your toes and test how much feeling you have in your toes. You may have blood tests to check for arthritis, diabetes, and infection.

Non Surgical Treatment

Putting padding between your toes and strapping them in place can help to stop pain caused by the toes rubbing. Custom-made insoles for your shoes will help to take the pressure off any painful areas. Special shoes that are wider and deeper than normal can stop your toes rubbing. However if your pain persists your consultant may recommend an surgery.

Surgical Treatment

Sometimes surgery can not be avoided. If needed, the surgery chosen is decided by whether we are dealing with a flexible or rigid hammer toe. If the surgery is on a flexible hammer toe, it is performed on soft tissue structures like the tendon and or capsule of the flexor hammer toe. Rigid hammer toes need bone surgeries into the joint of the toe to repair it. This bone surgery is called an arthroplasty.