Morton's neuroma

Answer 1

Definition

Morton's neuroma is a thickening of nerve tissue between the toes. It commonly affects the nerve that travels between the third and fourth toes.

See also: Foot pain

Causes, incidence, and risk factors

Morton's neuroma is more common in women than men.

The exact cause is unknown. However, some experts believe the following may play a role in the development of this condition:

• Abnormal positioning of toes
• Flat feet
• Forefoot problems, including bunions and hammer toes
• High foot arches
• Tight shoes and high heels

Symptoms

Symptoms of Morton's neuroma include:

• Tingling in the space between the third and fourth toes
• Toe cramping
• Sharp, shooting, or burning pains in the ball of your foot (and sometimes toes)
• Pain that increases when wearing shoes or pressing on the area
• Pain that gets worse over time

In rare cases, nerve pain occurs in the space between the second and third toes. This is not a common form of Morton's neuroma, but treatment is similar.

Signs and tests

A foot x-ray may be done to rule out bone problems. MRI or high-resolution ultrasound can successfully diagnose Morton's neuroma.

Nerve testing (electromyography) cannot definitely diagnose Morton's neuroma, but may be used to rule out conditions that cause similar symptoms.

Your doctor may order blood tests to check for inflammation-related conditions, including certain forms of Arthritis.

Treatment

Nonsurgical treatment is tried first. Your doctor may recommend any of the following:

• Padding and taping the toe area
• Shoe inserts
• Changes to footwear (for example, shoes with wider toe boxes)
• Anti-inflammatory medicines taken by mouth or injected into the toe area
• Nerve blocking medicines injected into the toe area
• Other painkillers
• Physical therapy

Anti-inflammatories and painkillers are not recommended for long-term treatment.

In some cases, surgery may be needed to remove the thickened tissue. This can help relieve pain and improve foot function. Numbness after surgery is permanent, but should not be painful.

Expectations (prognosis)

Nonsurgical treatment does not always improve symptoms. Surgery to remove the thickened tissue is successful in about 85% of cases.

Complications

Morton's neuroma can make walking difficult. Persons with this foot condition may also have trouble performing activities that put pressure on the foot, such as pressing the gas pedal of an automobile. It may hurt to wear certain types of shoes, such as high-heels.

Calling your health care provider

Call your health care provider if you have persistent pain or tingling in your foot or toe area.

Prevention

Avoid ill-fitting shoes. Wear shoes with a wide toe box.

References

El-Khoury GY, Bennett DL, Dalinka MK, et al. Expert Panel on Musculoskeletal Imaging. Chronic foot pain. Reston, VA: American College of Radiology; 2005.

Scardina RJ, Lee SM. Morton neuroma. In: Frontera, WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation.2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 85.

Answer 2

Definition

Morton's neuroma is an injury to the nerve between the toes, which causes thickening and pain. It commonly affects the nerve that travels between the third and fourth toes.

See also: Foot pain

Causes, incidence, and risk factors

Morton's neuroma is more common in women than men.

The exact cause is unknown. However, some experts believe the following may play a role in the development of this condition:

• Abnormal positioning of toes
• Flat feet
• Forefoot problems, including bunions and hammer toes
• High foot arches
• Tight shoes and high heels

Symptoms

Symptoms of Morton's neuroma include:

• Tingling in the space between the third and fourth toes
• Toe cramping
• Sharp, shooting, or burning pains in the ball of your foot (and sometimes toes)
• Pain that increases when wearing shoes or pressing on the area
• Pain that gets worse over time

In rare cases, nerve pain occurs in the space between the second and third toes. This is not a common form of Morton's neuroma, but treatment is similar.

Signs and tests

Your health care provider can usually diagnose this problem by examining your foot. A foot x-ray may be done to rule out bone problems. MRI or high-resolution ultrasound can successfully diagnose Morton's neuroma.

Nerve testing (electromyography) cannot diagnose Morton's neuroma, but may be used to rule out conditions that cause similar symptoms.

Blood tests may be done to check for inflammation-related conditions, including certain forms of arthritis.

Treatment

Nonsurgical treatment is tried first. Your doctor may recommend any of the following:

• Padding and taping the toe area
• Shoe inserts
• Changes to footwear (for example, shoes with wider toe boxes)
• Anti-inflammatory medicines taken by mouth or injected into the toe area
• Nerve blocking medicines injected into the toe area
• Other painkillers
• Physical therapy

Anti-inflammatories and painkillers are not recommended for long-term treatment.

In some cases, surgery may be needed to remove the thickened tissue. This can help relieve pain and improve foot function. Numbness after surgery is permanent, but should not be painful.

Expectations (prognosis)

Nonsurgical treatment does not always improve symptoms. Surgery to remove the thickened tissue is successful in about 85% of cases.

Complications

Morton's neuroma can make walking difficult. Persons with this foot condition may also have trouble performing activities that put pressure on the foot, such as pressing the gas pedal of an automobile. It may hurt to wear certain types of shoes, such as high-heels.

Calling your health care provider

Call your health care provider if you have persistent pain or tingling in your foot or toe area.

Prevention

Avoid ill-fitting shoes. Wear shoes with a wide toe box.

References

McGee DL. Podiatric procedures. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 51.

Davies AM, Grainger AJ. Techniques and imaging of soft tissues. In: Adam A, Dixon AK, eds. Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging. 5th ed. New York, NY: Churchill Livingstone; 2008:chap 45.

Reviewed By

Review Date: 06/06/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.