Morton's neuroma refers to the thickening of tissue enveloping the small nerve leading to the toes, particularly where the nerve traverses beneath the ligament connecting metatarsal bones in the forefoot. Unlike a growth, it represents an enlargement of normal nerve tissue in the front of the foot.
Typically found between the second/third and third/fourth toes, Morton's neuroma commonly arises from irritation, trauma, or undue pressure, with a higher incidence among women.
Symptoms
Symptoms of Morton's neuroma often mimic the sensation of walking on a foreign object like a stone or marble. This discomfort may manifest as burning pain in the ball of the foot, extending into the toes and exacerbated by activity or constrictive footwear. Numbness or a clicking sensation in the toes might also occur.
Diagnosis
Dr. Kamel may detect a mass or clicking sensation between metatarsal bones and induce pain by compressing the toe spaces. Range-of-motion tests help rule out joint inflammation or arthritis, while radiographs aid in excluding stress fractures or arthritis.
Initial treatment primarily revolves around non-surgical approaches:
- Footwear Modification: Opt for wider shoes with lower heels and soft soles to alleviate nerve compression.
- Orthotics: Custom inserts and pads can lift and separate bones, easing pressure on the nerve.
- Injection: Corticosteroid injections reduce nerve swelling and inflammation, providing relief.
Combining shoe adjustments, oral anti-inflammatory drugs, orthotics, and/or cortisone injections typically alleviates symptoms in over 80% of individuals. However, if conservative measures fail or symptoms recur, surgical intervention may be necessary.
Surgery entails either excising a portion of the nerve containing the neuroma or releasing surrounding tissue to decompress the nerve. It's typically performed as an outpatient procedure, allowing patients to return home the same day. Immobilization for 1-2 weeks facilitates incision healing, followed by a transition to regular shoes as tolerated.
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