Morton's Neuroma in Tunisia
Definition of Morton's Neuroma
Morton's neuroma is a benign (non-cancerous) swelling along a nerve in the foot that carries sensations from the toes. The reason why the nerve begins to swell is unknown. But once the swelling starts, the nearby bones and ligaments put pressure on the nerve, causing more irritation and inflammation. This produces burning pain, numbness, tingling, and other abnormal sensations in the toes. Morton's neuroma is also called interdigital neuroma, intermetatarsal neuroma, or forefoot neuroma.
A Morton's neuroma usually develops between the third and fourth toes. Less commonly, it develops between the second and third toes. Other locations are rare. It is also rare for a Morton's neuroma to develop in both feet at the same time. The condition is much more common in women than in men, probably due to wearing high-heeled, narrow-toed shoes. This style of shoe tends to shift the foot bones into an abnormal position, which increases the risk of a neuroma forming. Being overweight also increases the risk of Morton's neuroma.
Symptoms
Morton's neuroma typically causes burning pain, numbness, or tingling at the base of the third, fourth, or second toe. The pain may also spread from the sole of the foot up to the tips of the toes. In some cases, there is also the sensation of a lump, a sock fold, or a "hot pebble" between the toes.
Typically, the pain of a Morton's neuroma is temporarily relieved by removing your shoes, flexing your toes, and rubbing your feet. Symptoms may be worsened by standing for long periods or wearing high heels or narrow-toed shoes.
Diagnosis of Morton's Neuroma
Your doctor will suspect you have a Morton's neuroma based on the nature and location of your foot pain. He or she may ask questions about your shoes - what type of shoes you usually wear and whether these shoes have narrow toes or high heels. To rule out other causes of foot pain, your doctor may ask about your medical history, especially any history of arthritis, nerve and muscle problems, or previous injuries to the foot or leg.
To confirm the diagnosis, your doctor will examine your feet. He will look for areas of tenderness, swelling, calluses, numbness, muscle weakness, and limited movement. To check for Morton's neuroma, your doctor will press the sides of your foot. The compression should compress the neuroma and trigger your typical pain. In some cases, your doctor will find numbness in the webbed area between the affected toes. Pain in two or more locations on one foot, such as between the second and third toes and the third and fourth toes, more likely indicates that the toe joints are inflamed rather than Morton's neuroma.
Based on the physical examination, your doctor can usually diagnose Morton's neuroma without additional testing. An X-ray of the foot may be ordered to make sure there is no stress fracture, but it will not show the actual neuroma. If in doubt, your doctor may request a magnetic resonance imaging (MRI) of the foot.
Conservative and Home Treatments
Conservative treatment begins with using arch supports or pads for your shoes. These help relieve pressure on the affected nerve. They can be over-the-counter inserts or custom-made prescription ones to fit your foot. Your doctor may also suggest over-the-counter pain relievers or nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin) or aspirin. Other conservative treatments include:
Physical therapy
Stretching exercises to loosen tendons and ligaments
Massaging the sole of the foot
Exercises to strengthen your ankles and toes
Resting your foot
Applying ice to painful areas
Non-Surgical Treatment
If your pain persists, your doctor may try corticosteroid or anti-inflammatory medication injections into the painful area. An injection of local anesthetic may also be used to numb the affected nerve. This can help temporarily relieve your pain.
Alcohol sclerosing injections are another remedy that may provide short-term pain relief. However, a long-term study found that only 29% of people who received alcohol injections were symptom-free.
Surgical Treatment
When other treatments have failed to provide relief, your doctor may suggest surgery. Surgical options may include:
Neurectomy, where part of the nerve tissue is removed
Cryogenic surgery, also known as cryogenic neuroablation, where the nerves and the myelin sheath covering them are killed at extremely cold temperatures
Decompression surgery, where pressure on the nerve is relieved by cutting ligaments and other structures around the nerve
Expected Outcome
Your recovery time will depend on the severity of the Morton's neuroma and the type of treatment you receive. For some people, switching to wider shoes or insoles provides quick relief. Others may require injections and pain relievers to obtain relief over time.
Surgical recovery time varies. Recovery from nerve decompression surgery is quick. You will be able to bear weight on the foot and use a padded shoe right after surgery.
Recovery is longer for a neurectomy, ranging from 1 to 6 weeks, depending on the location of the surgical cut. If the incision is on the bottom of your foot, you may need to be on crutches for three weeks and have a longer recovery time. If the incision is on the top of the foot, you can put weight on your foot right away while wearing a special boot.
In both cases, you will need to limit your activities and sit with your foot above your heart level as often as possible. You will also need to keep the foot dry until the incision heals. Your doctor will change the surgical dressing in 10 to 14 days. How long after that you can return to work will depend on how much your job requires you to stand.
How to Prevent Recurrence
One of the easiest ways to prevent recurrence of Morton's neuroma is to wear the right type of shoes.
Avoid wearing tight shoes or high-heeled shoes for long periods.
Choose shoes that have a wide toe box with plenty of room to move your toes.
If recommended by the doctor, wear an orthopedic insert to remove pressure from the sole of the foot.
Wear padded socks, which can help protect your feet if you stand or walk a lot.
If you play sports, wear padded shoes to protect your feet.
If you spend a lot of time in the kitchen, at a cash register, or at a standing desk, get an anti-fatigue mat. These padded mats can help relieve your feet.