A neuroma develops when a nerve is compressed, injured or pinched, causing swelling and pain. A neuroma in the area between the third and fourth toes, or between the second and third toes, is known as a Morton?s neuroma. Morton?s neuroma causes sharp, burning pain and numbness in the toes and foot. You may feel like you?ve stepped on a tiny hot coal and can?t get rid of it. At the same time, you?ll have the disconcerting experience of not being able to feel your toes. Sometimes the nerve tissue becomes so thickened you can feel or see a lump.
Morton's neuroma may be the result of irritation, pressure or injury. In some cases its cause is unknown. In the majority of cases only one nerve is affected. Having both feet affected is extremely rare. A high percentage of patients with Morton's neuroma are women who wear high-heeled or narrow shoes. Patients with Morton's neuroma may need to change their footwear, take painkillers or steroid injections, while others may require surgery to either remove the affected nerve or release the pressure on it.
Patients with neuroma may develop pain on the bottom of the forefoot, most commonly under the 3rd and 4th toes, though any toe may be affected. The pain may be dull and mild or severe and sharp. The toes may feel ?numb? as times, especially the area between the 3rd and 4th toes. A classic complaint is that patients feel as if they are ?walking on a stone or pebble? and/or ?feel as if the sock is rolled up in the shoe.? Pain is often worse when walking barefoot.
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 attempts to reproduce your symptoms by manipulating your foot. Other tests or imaging studies may be performed. The best time to see your foot and ankle surgeon is early in the development of symptoms. Early diagnosis of a Morton?s neuroma greatly lessens the need for more invasive treatments and may avoid surgery.
Non Surgical Treatment
Wearing shoes that provide enough room in the toe box is also the first step in treating Morton?s neuroma. For instant relief when pain flares up, try taking your shoes off and rubbing the area. The nerve can get trapped below the ligament, and rubbing can move it back to its natural position. Your doctor or a foot-care specialist may recommend lower heels and metatarsal pads. These pads provide cushioning under your neuroma and better arch support to redistribute your weight. If you keep pressure off the toes and wear wide enough shoes, the problem may gradually disappear.
Surgery to remove the neuroma may be recommended if more conservative treatment does not solve the problem. While surgery usually relieves or completely removes the symptoms, it often leaves a permanent numb feeling at the site of the neuroma.