Morton’s Neuroma is a common condition found in the foot that plagues a large number of individuals every year. But for many general physicians, the symptoms of a legitimate Morton’s Neuroma may be unclear, and that’s where podiatrists like Daniel L. Wiernik, D.P.M. of Orlando Orthopaedic Center come in.
“A Morton’s Neuroma is basically a pinched nerve in the foot,” says Dr. Wiernik. “As the nerve gets pinched it gets swollen. The swollen pinched nerve creates pain, burning and numbness. This is what we refer to as a neuroma.”
Caused by an irritation of the plantar interdigital nerve in the foot, Morton’s Neuroma is not a true neuroma in that it is not a true tumor, but rather a perineural fibroma (a fibrous tissue formation around nerve tissue). The ultimate consequence of this growth is significant amounts of patient reported pain, and difficulties in performing normal tasks.
“The early signs include burning pain and radiating pain into the toes, usually it will be in between either the third or the fourth toe or the second and third toe. Other symptoms include a feeling of cramping in the foot or a shooting pain that radiates up the foot,” says Dr. Wiernik. “It’s also common to have significant discomfort walking barefoot on hard floors such as tile.”
Though benign, the condition is often very painful and is most commonly reported by middle-aged female patients due to their choice in footwear. The shooting pain that is consistent with diagnosis of the condition is found in the front or ball of the foot extending to the toes, usually in response to irritation, trauma, or excessive pressure.
The neuroma is an enlargement of a section of the nerve most commonly located in the third web spacing of the toes between the metatarsal heads, but can also be found in the second or fourth intermetatarsal space. The reason the nerve of the third intermetatarsal space is so prime for the condition is because the third common digital nerve found there is thicker as a result of being at the origin of the union of two different nerve branches.
Although the diagnosis of the condition is based primarily on reports of pain and a physical exam, two major modules can be used in identifying Morton’s Neuroma. These would include MRI and ultrasound.
When doing a physical examination, a web space compression test is often used and involves applying pressure and squeezing the metatarsal heads together with one hand and using the other free hand to compress the suspected affected area. If neuroma is present, pressure should cause pain, tingling, paresthesia, and a possible click and subsequent radiating pain into the toes.
Ultrasound techniques are another viable way of identifying a neuroma and two approaches, including the Dorsal approach, done by placing the ultrasound on the dorsal surface and pressuring the plantar foot, and the Plantar approach, done by placing the ultrasound on the plantar surface and squeezing the metatarsal heads together, provide accurate means of diagnosing Morton’s Neuroma.
Once diagnosed, physicians should encourage patients to make a conscious effort to minimize their symptoms by making necessary changes in footwear or by taking precautionary measures to insure their neuroma does not reach the point of surgical intervention.
“A candidate for a surgery on a Morton’s Neuroma is somebody who has a failed a conservative course of action by their doctor,” says Dr. Wiernik. “Those types of treatments could include oral anti-inflammatory medications, steroid injections, orthotic inserts, different types of shoes, and sometimes a modification in activities or exercises. Several attempts are made to resolve a patient’s symptoms before surgery is suggested.”
In surgery, the affected nerve mass is removed in its entirety through surgical excision, resulting in a permanent loss of sensation in the metatarsal area, but resulting in an overall reduction in pain for patients.
“All surgeries are not without risk. The most common surgery for Morton’s Neuroma by far is an excision of the nerve,” says Dr. Wiernik. Another surgery done less often is releasing a ligament to allow more room for the nerve. “There are other treatments besides surgery where doctors are injecting alcohol around the nerve. This is called a sclerosing injection. These are injections that are done in the office to try and relieve symptoms without actually having to do the surgery.”
Dr. Wiernik warns that the condition should not go untreated for a prolonged period. “Usually if the neuroma goes untreated it will not go away on its own. Often times it can cause some permanent damage to the nerve itself. Initially the nerve gets swollen and is treatable but if left untreated, that swelling can become permanent within the nerve.”
By Victor Ocasio