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Neuroma Defined & Explained
A neuroma is a thickening or a benign tumor of nerve tissue that may develop in various parts of the body. The most common neuroma occurs in the foot known as Morton’s neuroma or an intermetatarsal neuroma, which surrounds the digital nerve leading to the third and fourth toes. It occurs as the nerve passes under the ligament connecting the toe bones (metatarsals) in the forefoot. Neuromas may also occur in other locations in the foot.
The thickening is the result of compression and irritation of the nerve which results in its enlargement, eventually leading to permanent nerve damage. Morton’s neuroma most frequently develops between the third and fourth toes, usually in response to irritation, trauma or excessive pressure, although it’s not usually visible or noticeable under the skin. The incidence of Morton’s neuroma is 8 to 10 times greater in women than in men.
Causes Leading To Morton’s Neuroma
The most common causes related to Morton’s neuroma can be listed as below:
- Injury Or Trauma to the area leading to a probable neuroma
- Ill-fitting Footwear that is narrow-shaped at the front with tapered toe-box or high-heeled
- Foot Deformities, such as bunions, hammertoes, flatfeet or more flexible feet putting the patients at higher risk for developing a neuroma
- Activities that involve repetitive irritation to the ball of the foot, such as running or indoor court sports
- Excess Pressure on your toes giving rise to neuroma symptoms
- Excessive Elasticity of ligaments and calf muscle issues
- Thinning Of The Fat Pad that covers the ball of the foot, causing increased pressure on the nerves
The Signs & Indications Of Morton’s Neuroma
If you are suffering from Morton’s neuroma, you may present one or more of the below mentioned symptoms where the nerve damage is occurring:
- Tingling Or Numbness in the affected area
- Pain & Discomfort in the thickened zone
- Burning Pain in the ball of the foot radiating into the toes
- A Feeling of something being inside the ball of the foot
- A Sensation of there being something in the shoe or a sock is rolled up
- Augmentation In Pain with activity or wearing shoes
The Visible Progression Of Morton’s Neuroma
Morton’s neuroma, if neglected and left unattended, often progresses in the following sequence:
- The symptoms and indications kick off gradually.
- Firstly, the symptoms are visible only seldom when wearing narrow-toed shoes or performing certain high impact activities.
- The symptoms usually disappear temporarily by removing the shoe, massaging the foot or avoiding exacerbating shoes or activities.
- With the passage of time, the symptoms progressively worsen and may persist for several days or weeks even if the aggravating factors have been done away with.
- The symptoms take up a more intense form as the neuroma lump enlarges and the temporary changes in the nerve are turned permanent.
The Diagnostic Process Of Morton’s Neuroma
Diagnosis of Morton’s Neuroma can be difficult and sometimes it takes several thorough examinations and precise evaluation to identify the neuroma. Your expert podiatrist would perform a thorough medical examination of your foot that usually includes the following:
- A Thorough Medical History for careful decision-making
- A Detailed Physical Examination for general assessment and ruling out other foot conditions
- Imaging Techniques that include:
- Ultrasound Scans
- MRI Scans
The Treatment Means Of Morton’s Neuroma
There are conservative treatments for neuroma, as well as surgical procedures that a foot specialist can effectively decide on. Your podiatric doctor would consider a number of factors prior to determining the course of treatment:
- General Health
- Foot Type
- Presented Symptoms
- Severity Of The Neuroma
- Stage Of Neuroma Development
The Conservative Treatment Approach
Most conservative therapies are relatively simple and directed at eliminating or decreasing your pain and symptoms. For mild to moderate neuromas they can involve one or more of the following treatment options:
- Shoe Modificationsby wearing shoes with a wide toe-box and proper fit, and avoiding narrow-toed or high-heeled shoes can help a lot.
- Icingby placing an icepack on the affected area helps reduce swelling.
- Paddingtechniques provide support for the metatarsal arch, lessening the pressure on the nerve and decreasing its compression while walking.
- Wearing shoes with additional cushion imparts comfort and relaxation to the affected foot.
- Activity Modifications by shunning activities that put repetitive pressure on the neuroma improves the condition considerably.
- Orthotic Devices that are custom-made provide the support needed to reduce pressure and compression on the nerve.
- Preventing Irritation from friction by applying special protective pads can help in lessening the discomfort.
- Medications in the form of oral NSAIDs may be recommended to reduce pain and inflammation.
- Injection Therapy may comprise of injections of cortisone, local anesthetics or other analgesic agents.
- Limiting Nerve’s Ability to detect and communicate pain by administering sclerosing injection (an alcohol injection) can provide temporary pain relief.
- Losing Weight to reduce pressure on balls of the feet can control the condition.
The Invasive/Surgical Approach
If you have not responded adequately to conservative treatments so that your symptoms are not relieved, your orthopedic surgeon will determine the approach that is best for your condition and may consider surgical treatment options for you.
The surgical procedure can resect a small portion of the nerve or release the tissue surrounding the nerve, and generally involves a relatively brief recovery period. The process is relatively simple and straightforward in performance, as outlined below:
- Surgery is carried out under a general anesthetic.
- An injection is administered in the foot to numb it against pain after surgery.
- The surgeon makes a tiny incision on the top of the foot between the toes over the painful neuroma.
- The neuroma is then carefully removed.
The Risks & Complications
- Infection at the site of the wound
- Toe Stiffness to be helped with physiotherapy
- Deep Vein Thrombosis (DVT) that is treated with blood-thinning medication
- Recurrence Of The Neuroma treated usually with injections or revision surgery with 60-70% success