Morton’s Neuroma

Description

Morton’s neuroma is a swollen nerve in the distal portion of the foot. The enlarged portion of the nerve represents scarring within the plantar nerve that occurs after chronic compression and/or repetitiveinjury.   This may come about when the toes are squeezed together for too long, as can occur with the chronic use of high heels.  The nerve that runs between your toes will swell and thicken. This can cause pain when walking. The symptoms of Morton’s neuroma can include burning pain in the foot, the feeling of a lump inside your foot, pain between the third and fourth toes typically but it can occur between other toes (Figure 1).

Diagnosis

Morton’s neuroma can be identified during a physical exam, after pressing on the bottom of the foot.  This maneuver usually reproduces the patient’s pain. MRI and ultrasound are imaging studies that can demonstrate the presence of the neuroma.  An x-ray may also be ordered to make sure no other issues exist in the foot.  A local anesthetic injection along the neuroma may temporarily abolish the pain, and help confirm the diagnosis.

Treatment

Anti-inflammatory drugs may be recommended to dull the pain and lessen swelling. Neuropathic pain medications such as the antionvulsants and / or antidepressants may be tried as well.  Many are able to recover from this issue at home by icing the area, resting the feet, and by avoiding wearing narrow or tight shoes. If these remedies do not work to alleviate symptoms, the doctor may give special devices to separate the toes and avoid the squeezing of the nerve. Steroid injections may reduce pain and swelling. Surgery may be required if these do not help.  Surgery typically involved removal of the neuroma through an incision in the foot (Figure 2).