What is Morton’s Neuroma?
Morton’s neuroma is an inflammation and thickening of the interdigital nerve (which lies between the bones of the toes) that causes pain and discomfort in the feet. It was first described by Thomas G. Morton, in 1876, where it comes from, as a benign tumor lesion caused by fibrosis of the digital plantar nerve.
In other words, the neuroma is nothing more than a small mass that forms around the nerve that passes at the bottom of the foot, where it divides to go to the fingers (between the metatarsals), causing pain and discomfort .
The disease is curable . Its treatment is through therapies or surgical intervention. Surgery to treat Morton’s neuroma is one of the most successful and safest in the field of orthopedics.
Although there is no consensus on the cause of the disease, the most plausible hypothesis is that it occurs due to the use of high heels, tight shoes and intense sports.
The disease is much more common in women than in men. Approximately 8 out of 10 patients suffering from Morton’s neuroma are women.
The diagnosis of Morton’s neuroma is simple and many tests are usually not necessary. In most cases, the simple feeling of the doctor in the region of pain can diagnose the presence of the disease with a certain degree of certainty.
People with deformities in their feet, such as bunions and flat feet, are more likely to acquire Morton’s neuroma throughout their lives.
There are not many complications related to Morton’s neuroma, except pain in the feet, difficulty walking and practicing daily activities.
The best way to prevent the disease is through the use of comfortable and spacious shoes, in addition to resting between physical activities and the practice of massaging your feet regularly, to stimulate blood circulation.
The interdigital nerve is part of the plantar nerves, a series of nerves that are in the area of the feet and serve for the brain to recognize the touch in this region.
Morton’s neuroma is caused by a swelling of the interdigital nerve. The pains caused by inflammation of this nerve are uncomfortable and need to be observed and treated with caution.
Depending on the severity of the inflammation of the interdigital nerve, surgical interventions that involve removing structures close to it or even removing the nerve itself may be alternatives to relieve pain.
Morton’s neuroma occurs when the interdigital nerve (which lies between the bones of the fingers) becomes irritated, which makes it thicker and more sensitive. The exact cause of this irritation is still unknown to medical science, but the main hypothesis is that it is caused by excessive pressure in this region.
However, in general, it works like this: the metatarsals, bones of the foot, have reduced space between them and pinch the structures that pass between them. With this, the disorderly growth of the interdigital nerve begins, which usually passes between the third and fourth metatarsals.
This nerve increases in size, which further worsens its compression, causing discomfort and pain in the region.
So far, the main suspects for being responsible for Morton’s neuroma are:
- Wear tight, pointed shoes or high heels;
- Practice high-impact sports, such as running and any activity that puts a lot of pressure on your feet;
- Other foot deformities, such as flat feet, bunions or black feet.
In addition to the main causes, one of the groups that is most likely to acquire Morton’s neuroma throughout life are people over 40 or 50 years old, as the stress on the bones of the foot is cumulative, increasing over the years.
In addition, when we age, we tend to gain more weight, which increases the pressure placed on the feet.
There are no obvious symptoms of Morton’s Neuroma, such as lumps or the like, but some signs can show the existence of the problem. Are they:
- The feeling of stepping on a rock or ball lasts whenever you support your foot on the ground;
- A sharp, burning-like pain in the back of the foot (the one closest to the toes) that can spread to the toes;
- Tingling or chronic numbness in the fingers.
This pain in the feet usually worsens a lot when going up or down the stairs, as the toes stretch, causing a hyperextension that tightens the already inflamed nerves of the feet.
A sensation of shock between the 2nd and 3rd or 3rd and 4th toes are the most common signs that a disease like Morton’s neuroma is present.
In addition, in some cases, the toes also move away from each other because of the inflammation between the metatarsals.
When to seek medical assistance?
It is good that you pay attention to the signs and do not ignore the pain you feel in your feet for more than a few days. More than that can be risky.
If the pain you feel in the soles of your feet is not improving, even after changing your shoes for other less tight models and avoiding intense physical activities, it is best that you seek a doctor who specializes in the subject.
The diagnosis is usually made during an appointment with the doctor. However, he can order additional tests to be sure.
During the consultation, the doctor will touch your foot looking for lumps, masses or tender points. You may feel “crackles” between the bones of your foot during the exam.
Some imaging tests can serve as complementary tests to diagnose the disease with a greater degree of certainty. Are they:
Most likely the doctor will order an x-ray of your feet. This is done to rule out other illnesses that may be causing you to experience pain in your feet, such as a fracture caused by stress.
This exam uses sound waves to create real-time images of internal body structures. It is particularly effective for revealing abnormalities in internal tissues, such as neuromas.
This test uses radio waves in conjunction with a strong magnetic field to visualize soft tissues. However, it is a very expensive procedure.
Morton’s neuroma can be confused with other very common diseases, such as capsulitis, intermetatarsal bursitis , metatarsal stress fracture, rheumatoid arthritis, plantar calluses associated with a hammer or claw finger or tarsal tunnel syndrome.
Therefore, the tests mentioned above can serve to make a differential diagnosis, that is, to rule out the possibility of these other diseases, or even the possibility of the pain being caused by the neuroma itself.
The best thing to do is to look for an orthopedist. He will know what tests to do and will rule out any other illnesses that may be related to the pain you are experiencing.
If you feel that the pain in your feet is bothering you a lot and bringing problems to your day-to-day life, it is very important that you go to a doctor. Usually, for these cases, a podiatrist will be indicated for you. Although it sounds like a bad word, a podiatrist is nothing more than a doctor specializing in feet.
In addition to the podiatrist, doctors such as the general practitioner, orthopedists, neurologists, rheumatologists and infectologists can also diagnose the disease.
It is important that, before the medical consultation, you pay attention and tell the doctor what types of shoes you use in your daily life, the frequency of symptoms and possible recent foot injuries.
Morton’s neuroma is curable . The most effective way to treat the disease is through surgical interventions, but they are not always necessary, and treatments that seek only to relieve symptoms can be done.
Treatment will depend on the severity of the symptoms. The doctor will usually recommend milder therapies before considering any type of intervention.
To decrease pain, inflammation and improve movement and support of the foot, physical therapy may be indicated. It is not able to completely eliminate the lump that has formed, but it can decrease its size, relieving pain and helping to improve the anatomy of the foot, which decreases the chances of a new neuroma to form.
Some of the physical therapies that can be indicated are:
Ultrasound with anti-inflammatory gel
For an estimated time of about 5 minutes, the doctor will do an ultrasound with anti-inflammatory gel at the exact location of the foot pain. In this technique, ultrasound enhances the anti-inflammatory effect, increasing the penetration of the medication through the skin and tissues.
Mobilization of metatarsals and toes
It is nothing more than a massage on the plantar musculature, which serves to relieve the pressure that the neuroma suffers from the metatarsals and the increased muscle tension due to pain.
Deep transverse massage
Another massage, this serves to break the fibrosis points of the nerve, relieving the pain.
Stretching helps to improve flexibility in the affected area by loosening tendons and ligaments.
It is done after the foot has already gained some mobility due to other therapies. Thumb exercises help to strengthen the muscles affected by the neuroma.
They include picking up a pencil on the floor using only your toes or crossing the room only on tiptoes. By strengthening these muscles, the risk of developing the disease again tends to decrease.
Since Morton’s neuroma can bring weakness beyond your feet, even affecting your ankle, it is important to strengthen those muscles as well. Thus, exercises for this type of treatment include walking around a room using only your heels or writing the alphabet in the air with your thumb.
Performing these exercises helps to strengthen the muscles of the ankle and foot and helps the patient to return to their normal activities.
Combined with physical therapy, electrotherapy is a great way to eliminate the symptoms of pain and discomfort caused by Morton’s neuroma.
It consists of applying electrical impulses to muscles in the body to interfere with the neural transmissions of pain signals to the brain. Through this stimulation, the body’s tissues produce endorphins, a natural and potent analgesic that will be interpreted in the brain instead of pain signals.
In addition, the application of these electrical currents to the muscles can serve to decrease muscle atrophy and assist in the recovery of muscles after some surgical procedure or severe injuries.
The main type of electrotherapy used for pain relief is Transcutaneous Electrical Nerve Stimulation (TENS).
In TENS, a small electrical device, usually powered by a battery, controls the intensity of the applied electrical stimuli, while small electrodes placed on the skin in the region of pain cause the current to reach the muscles.
The application of electric currents helps to reduce pain for long periods and the treatment sessions, being very uncomfortable most of the time, do not last more than 20 to 30 minutes.
Use of special insoles
The use of orthopedic insoles in shoes can help to reduce the pressure imposed on the toes and soles. They can be purchased at any shoe store, or even online .
The doctor can also prescribe an individual insole, made just for this purpose, modeled with the exact contours of your foot, for a more peaceful and effective recovery.
Lifestyle changes and home remedies
To help relieve the pain that comes with Morton’s neuroma and allow the nerve to heal without major complications, you can follow these steps:
Massaging your feet regularly with ice is a practice that can help reduce pain. Immersing your feet in a basin with ice for 15 minutes can be a great option to improve the feeling of pain caused by the disease;
Avoid wearing high heels or tight shoes is a great way to both prevent the disease and treat your symptoms. Choose shoes with plenty of space for your toes and soles;
Staying at home for a few weeks and reducing the frequency of physical activities, such as running, aerobic exercise or dancing is a good idea. This way you will not be subjecting your feet to high impact activities, which will speed up the healing process.
If you are overweight, this may be one of the reasons your foot is under so much pressure. Losing weight and starting to lead a healthier life can be a very functional option to reduce the problem.
If none of these other types of treatment work, your doctor may suggest:
Some people experience relief from symptoms when using steroids in the affected areas.
In some cases, surgical intervention can help to relieve pressure on the nerve. In decompression surgery, structures around the nerve, such as ligaments and structures in the front of the foot, are cut, relieving pain.
Only done as a last resort, removal of the nerve is only necessary if none of the other alternatives has been effective in reducing pain. It is considered one of the safest operations in the field of podiatry (foot medicine), but despite this, it can result in symptoms such as permanent numbness of the toes.
An alternative treatment for people who do not want or cannot undergo surgery is acupuncture. This ancient technique consists of applying pressure to certain specific nerves in the body with the use of a needle specially designed for this purpose.
Generally, 1 session per week is performed, in which the acupuncturist will apply these needles to the affected nerves, feet, or other areas of the body that he deems necessary. This type of treatment helps to relieve tension, rebalance the body’s energies, decrease tension and stress, in addition to alleviating discomfort.
The use of anti-inflammatory drugs can be a palliative to alleviate the pain caused by Morton’s neuroma, as they help to reduce the swelling of the interdigital nerve. Are they:
- Iboprufeno ;
- Naproxen ;
- Dipyrone .
In addition to these medications, the use of analgesics is an option to relieve pain, such as:
- Piroxicam .
In addition, local anesthetics can be indicated for the same functionality, such as:
- Xylocaine ;
- Lidocaine ;
Injecting corticosteroids at the site of the pain can help relieve symptoms. Sclerotherapy (sclerosing injection) can also be a solution.
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Apart from discomfort and pain, there are not many complications related to Morton’s neuroma. So living with the disease is easier than it may seem.
If you have been diagnosed with Morton’s neuroma, medical follow-up and the practice of certain activities may be essential to prevent the disease from developing and becoming more severe.
Wearing the proper shoes and massaging your feet regularly stimulates circulation. Massaging with ice can help to reduce pain in the area and relieve symptoms. Taking the time to rest your muscles between physical activities is also highly recommended, as without it, the chances of the disease getting worse only increase.
There are not many complications caused by Morton’s neuroma. The most common ones, in fact, are an increase in the difficulty of walking and in the practice of daily activities, such as driving, wearing high heels, walking and exercising.
They are easily treatable and will not bring many problems, as long as medical help is sought at the right time.
However, after surgical intervention there may be some complications.
Although rare, complications do happen. In the postoperative period, what can happen, immediately, is the appearance of bruises, healing problems and infections.
In the long run, what can happen is pain due to recurrence of the local or adjacent neuroma, that is, pain caused because the surgery did not cover all the necessary areas.
The best way to prevent it is to alternate wearing shoes . Avoid wearing shoes that are too tight, or wear them only on certain occasions. Making use of comfortable and spaced shoes during the day-to-day is a very safe and effective option to avoid the problem.
In addition, being attentive to physical exercise and massaging your feet regularly helps to decrease sensitivity, decrease tissue stiffness and improve the space to decrease neuroma compression.
Giving the necessary rest time for this part of the body makes it difficult to appear in Morton’s neuroma, and it is also a good choice. Make regular appointments with your doctor and see what physical activity is right for you.
Morton’s neuroma is a disease that affects the feet. It has no very serious complications and can be easily resolved. Even so, care must be taken and be attentive to the symptoms of the disease, as it can bring a lot of discomfort, pain and disrupt your daily practices.
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