What is Intermetatarsal Neuroma, also known as Morton’s Neuroma?
Pain in the ball of the foot is a common problem in the foot and
ankle, and a common cause of this is irritation of one or more of
the nerves on the bottom of the foot. This is called a neuroma, a
condition where the nerves passing underneath the forefoot
become inflamed and can thicken. This thickening makes
irritating the nerve even easier, often leading to worsening
symptoms. The most common place for a neuroma is between
the third and fourth toes, though other locations are common.
What are the symptoms and causes?
Initially, most people notice some numbness or fullness in their
forefoot, especially with tight shoes and prolonged standing,
walking, hiking, or running. Over time, the sensation can
become painful, commonly progressing to a painful, burning
sensation to often radiates into the toes. This can make
previously enjoyable activities painful and sometimes
significantly limits normal daily function.
How is it diagnosed?
Diagnosing a neuroma can be difficult. It’s not likely that you will
be able to feel the swelling around the nerve. Inflammation of
the small joints of the forefoot (metatarsophalangeal capsulitis/
synovitis) can present similarly to a neuroma, and it is not
uncommon for these two conditions to exist at the same time.
An x-ray will not show a neuroma, but is usually ordered to rule
out other problems. In most cases the diagnosis is made based
on your symptoms and physical exam, however, sometimes an
MRI is ordered if the diagnosis is questionable. Unfortunately,
most neuromas are not visible on MRI, and the MRI is used to
look for other problems in the area. Ultrasound is also
occasionally used, but is not always reliable.
What are the treatment options?
Conventional Treatment:
Once you have been diagnosed with a neuroma, you have
several options. Avoiding narrow shoes and shoes without good
support is very important. Mildly symptomatic neuromas can be
treated with occasional nonsteroidal antiinflammatories
(NSAIDS) such as ibuprofen or naproxen. A small device called a
metatarsal pad can be placed in shoes, and is sometimes very
helpful. Stretching your calf muscles may reduce the pressure
on your forefoot and can improve symptoms.
Injection of cortisone (steroid) into the forefoot is often a good
option, as it sometimes provides long-lasting relief and may be
helpful in confirming your diagnosis. Multiple steroid injections,
especially in close succession, however, is not advised due to
the possibility of thinning the protective fat pad of the forefoot
and potentially weakening tendons and ligaments in the toe
joints.
Other conservative treatments are controversial and have
limited evidence. These include laser therapy, alcohol injection,
and cryoablation. Current literature does not support alcohol
injection and cryoablation.
Surgical Treatment:
If you have not had success with conservative treatments,
surgery is an option. Surgical treatment involves releasing the
ligament over the nerve and removing the neuroma. This results
in a small area of numbness between the two toes on either side
of the neuroma, though this is generally unproblematic and a
welcome trade-off for the resulting pain relief. Recent studies
show that over eighty percent of patients have successful
outcomes. Surgical removal of the neuroma involves 4 weeks of
walking on your heel in a surgical shoe or boot, followed by
gradual return to activity. Full return to prior activity is expected
after you are recovered.
Meet Your Foot Doctor!
Dr. Evan N. Simonson, DPM, as known as Doctor of Podiatric Medicine, specializes in foot and ankle surgery. He diligently diagnoses and educates his patients of all surgical and non-surgical options for their condition. His patients are in complete control of their outcome while having a trusted partner for guidance.
