What Is Mortons Neuroma

Overview

interdigital neuromaA neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton?s neuroma, which occurs between 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. Neuromas may also occur in other locations in the foot. MortonThe thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage.

Causes

Morton’s neuroma is an inflammation caused by a buildup of fibrous tissue on the outer coating of nerves. This fibrous buildup is a reaction to the irritation resulting from nearby bones and ligaments rubbing against the nerves. Irritation can be caused by Wearing shoes that are too tight. Wearing shoes that place the foot in an awkward position, such as high heels. A foot that is mechanically unstable. Repetitive trauma to the foot such as from sports activities like tennis, basketball, and running. Trauma to the foot caused by an injury such as a sprain or fracture. It is unusual for more than one Morton’s neuroma to occur on one foot at the same time. It is rare for Morton’s neuroma to occur on both feet at the same time.

Symptoms

Feelings of numbness, tingling or tenderness in the ball of the foot (the area just behind the base of the toes) are some of the first signs of a condition known as Morton?s Neuroma. However, the condition is somewhat unpredictable, and symptoms may vary from patient to patient. Generally, however, the discomfort gets worse rather than better, and the patient may feel pain or a burning sensation that radiates out to the toes. Eventually, wearing shoes becomes uncomfortable (or even unbearable), and the patient may complain that the feeling is similar to that of having a stone bruise, or walking on a marble or pebble constantly, even though no there is no trauma to the skin, and no visible bump or lump on the sole of the foot.

Diagnosis

Plain x-rays of the foot may demonstrate that one or more of the metatarsals are long (Figure #5). Not uncommonly, the second and/or third metatarsal may be long relative to the third or fourth. This can create a situation where excessive load is occurring in and around the vicinity of the interdigital nerve.

Non Surgical Treatment

Rest. Continuing with normal training will increase pain and inflammation and prevent the injury from healing. Wear a metatarsal pad under the forefoot which will raise and spread the bones of the forefoot taking the pressure off the nerve. Wearing metatarsal pads in the shoes under the forefoot spreads the metatarsals creating more space for the nerve. See a sports injury professional who can advise on treatment and rehabilitation. Orthotic inserts may be required to correct any biomechanical dysfunction of the foot.intermetatarsal neuroma

Surgical Treatment

About one person in four will not require any surgery for Morton’s neuroma and their symptoms can be controlled with footwear modification and steroid/local anaesthetic injections. Of those who choose to have surgery, about three out of four will have good results with relief of their symptoms. Recurrent or persisting (chronic) symptoms can occur after surgery. Sometimes, decompression of the nerve may have been incomplete or the nerve may just remain ‘irritable’. In those who have had cutting out (resection) of the nerve (neurectomy), a recurrent or ‘stump’ neuroma may develop in any nerve tissue that was left behind. This can sometimes be more painful than the original condition.

Causes Of Hammertoes

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Hammer ToeOverview

Hammer toes are classified based on the mobility of the toe joints. There are two types. Flexible and rigid. In a flexible hammertoes, the joint has the ability to move. This type of hammer toe can be straightened manually. A rigid hammer toe does not have that same ability to move. Movement is very limited and can be extremely painful. This sometimes causes foot movement to become restricted leading to extra stress at the ball-of-the-foot, and possibly causing pain and the development of corns and calluses.

Causes

The incorrect position of the person’s toes inside of their shoes also causes the formation of calluses or corns on the surfaces of their toes which are constantly bent as they are wearing inappropriate shoes because the surfaces are consistently rubbing hammertoe against the hard materials of the interior of the shoes causing regular friction.

HammertoeSymptoms

The symptoms of hammertoe are progressive, meaning that they get worse over time. Hammertoe causes the middle joint on the second, third, fourth, or fifth toes to bend. The affected toe may be painful or irritated, especially when you wear shoes. Areas of thickened skin (corns) may develop between, on top of, or at the end of your toes. Thickened skin (calluses) may also appear on the bottom of your toe or the ball of your foot. It may be difficult to find a pair of shoes that is comfortable to wear.

Diagnosis

Although hammertoes are readily apparent, to arrive at a diagnosis the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, the foot and ankle surgeon may take x-rays to determine the degree of the deformities and assess any changes that may have occurred.

Non Surgical Treatment

Symptomatic treatment of hammertoes consists of such things as open toed shoes or hammertoe pads. There are over the counter corn removers for temporally reducing the painful callous often seen with the hammertoe. These medications must be used with caution. They are a mild acid that burns the callous off. These medications should never be used for corns or callouses between the toes. Persons with diabetes or bad circulation should never use these products.

Surgical Treatment

Hammer toe can be corrected by surgery if conservative measures fail. Usually, surgery is done on an outpatient basis with a local anesthetic. The actual procedure will depend on the type and extent of the deformity. After the surgery, there may be some stiffness, swelling and redness and the toe may be slightly longer or shorter than before. You will be able to walk, but should not plan any long hikes while the toe heals, and should keep your foot elevated as much as possible.