Do you sometimes feel like there's a pebble in your shoe that causes irritation and pain when you walk? Do you experience numbness in your toes? It's likely that you have Morton's neuroma. The question arises, who is this Morton and what is his neuroma? I will tell you about it today!
WHY MORTON'S NEUROMA?
Like many diseases named after people, this one got the name Morton because of the physician, Thomas George Morton, who first described this condition. But what is a neuroma? It is a thickening of the tissue covering a nerve. This thickening causes the nerve to be compressed and produces typical symptoms.
WHAT SYMPTOMS ARE TYPICAL OF MORTON'S NEUROMA?
Most often, this pathology affects the nerve running between the third and fourth metatarsals (but not necessarily), so the symptoms are related to this location. The main symptom is pain precisely at the site of the neuroma, radiating to the third and fourth toes of the foot. This pain typically increases after physical activity, standing, or walking. Patients often describe this pain as a "pebble in the shoe", a burning, "shooting" pain. Since the nerve is irritated, other neurological symptoms such as decreased sensation or numbness in the toes may also occur.
WHY DOES MORTON'S NEUROMA FORM?
The exact causes of this condition are not fully understood, but scientific literature suggests that irritation of this nerve can occur due to a decrease in the transverse arch of the foot. As the arch flattens, surrounding tissues compress, irritate, and damage the nerve, leading to nerve inflammation and thickening. One of the risk factors is wearing high heels, as they place more stress on the front part of the foot, where this often-affected nerve is located. Therefore, this pathology is diagnosed five times more often in women.
HOW DOES AN ORTHOPEDIC TRAUMATOLOGIST DIAGNOSE THIS CONDITION?
Usually, just by hearing the patient's complaints, we can suspect Morton's neuroma. We also always clinically evaluate the foot. We perform a test called Mulder's sign. We grasp the foot on both sides and lift one part of the foot upwards with one hand while pressing down with the other, thus creating movement between the third and fourth metatarsals, where Morton's neuroma is typically found. If pain is felt during this test, we have confirmation. However, for a definitive diagnosis, we usually perform an ultrasound examination of the foot, which reveals nerve thickening.
WHAT IS THE TREATMENT FOR MORTON'S NEUROMA?
To reduce the load on the front part of the foot, we recommend wearing special orthopedic insoles that reduce nerve compression. It is also advisable to avoid narrow shoes so that the metatarsals are not compressed and do not irritate the nerve further. For symptom relief, we prescribe foot exercises to strengthen the intrinsic foot muscles. If there is no good result, glucocorticoid (hormone) injections can be administered into the affected area of the foot, thereby reducing inflammation.
However, if symptoms persist for 9-12 months and other treatments are ineffective, then surgical treatment is necessary, which is usually very successful. According to scientific studies, as many as 80-90% of patients experience complete symptom relief after surgery!
WHAT DOES THE SURGERY LOOK LIKE?
During the surgery, a several-centimeter incision is made on the top of the foot between the third and fourth metatarsals. Surrounding tissues, ligaments, and fascia that cause compression are released. In severe cases of Morton's neuroma, the nerve may be removed, but then a part of the foot becomes numb. Of course, you should discuss the most suitable surgical method with your doctor.
After the surgery, patients are usually discharged home on the same or next day. At home, it is necessary to wear a special brace that limits the load on the front part of the foot, and a return to normal daily activities can be expected after 3-6 weeks.
HOW TO AVOID THIS PATHOLOGY?
1. Avoid narrow shoes.
2. After wearing high heels, perform foot exercises and massages to prevent the transverse arch of the foot from flattening.
3. Wear orthopedic insoles to reduce the load on the front part of the foot.
4. If you experience symptoms, contact an orthopedic traumatologist to start treatment on time and avoid surgery!
Do you have questions? Write to me, and we will try to find the most suitable solution for your problems together!
Karolina
