A Morton’s Neuroma is an irritation and swelling of a nerve which lies between the long bones in the foot (metatarsal bones), causing discomfort in the.ball of the foot and adjacent toes. It may also called an intermetatarsal neuroma due to its location between the metatarsal bones.
The irritation or compression around the nerve leads to the tissue which surrounds it (myelin sheath) becoming thickened, and subsequently compressing the nerve further. It most commonly occurs between the third and fourth toes but can happen between any.
It is most often caused by footwear, shoes that are too tight or high heels. These shoes can cause the nerve in the foot to become compressed or irritated. Other possible causes may be due to foot structure or the way that someone walks.
It is often associated with:
Symptoms of nerve disturbances around the ball of the foot and toes, such as numbness and tingling, tending to be intermittent, and usually aggravated by certain types of footwear. Feeling as if there is something in the ball of the foot, like standing on a marble or pebble in the shoe. There may be difficulty walking normally due to pain, there isn't usually any visible redness or swelling around the area. Usually the pain is relieved by massage, rest or removing the footwear.
Symptoms differ from person to person. Symptoms may include:
To rule out any other possible causes of the pain such as arthritis or a stress fracture, a podiatrist may request a referral onwards for imaging of the foot. This may be:
If the podiatrist may suspect another condition affecting the nerves, they may refer onwards to have an electromyography, this test measures the electrical activity produced by nerves which can help the podiatrist to understand better how well the nerves in the foot are functioning.
The aim of podiatry treatment for a Morton's neuroma is to reduce and relieve pressure around the nerve.
This can be done in a number of ways such as;
If conservative methods fail, there are other more invasice treatments which can be offered such as steroid injections, acupuncture, and surgical removal of the neuroma. If this may be indicated podiatrists can write a report and request a referral onwards to secondary care.
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