What is a Morton’s neuroma?
The sensation to the toes is mediated by nerves. The major nerves pass around the back and inside of the ankle, branch into medial and lateral plantar nerves in the arch and finally into individual interdigital nerves that travel into the toe webs giving sensation to adjacent sides of the toe.
The nerves can get irritated in the ball of the foot. They begin to cause the toes to tingle. Enlargement of the nerves can click and pop. Pain with prolonged usage can be felt in the “ball of the foot”.
Other problems that can be confused with Morton’s neuroma are:
- Other nerve injuries
- Tarsal tunnel syndrome.
- Diabetic nerve damage
- Ligament tears in the ball of the foot
- Painful Corns and calluses
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What causes Morton’s neuroma?
There are several thoughts on this, but no one knows for sure.
As the nerves pass into the foot, they go underneath a ligament that link the metatarsal bones. The ligament may bite into the nerve as pressure is applied to the front of the foot.
This condition is much more common between the third and fourth toes than it is between other toes. This nerve receives branches from both the medial and lateral plantar nerves and is slightly larger. This may make it slightly more prone to injury. The dual nerve supply may also tether the nerve and cause it to become injured.
Finally, the fourth and fifth metatarsal rays are more flexible than the second and third rays. The fact that this nerve lies at the junction between the more and less flexible rays may increase the potential for injury.
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How do I get better?
Non-steroidal anti-inflammatory medications such as ibuprofen and naprosyn are effective pain medications,but do little to cure Morton’s neuroma. Injections of cortisone or steroid around the nerve are helpful in reducing the inflammation and often seem to cure the problem,
Activities that place a great deal of stress on the forefoot such as jogging and sports may need to be temporarily curtailed and replaced by other activities such as bicycling and swimming.
Shoe wear that prevents concentration of pressure on the forefoot is very helpful. Rocker-soled shoe wear or toners are very effective at this. These shoes are made by many companies including Dansko, MBT and Skechers and are all slightly different in fit and feel. Arch supports seem to give relief also, but people are just as satisfied with inexpensive over-the-counter arch supports as expensive custom arch supports.
Postural training and rehabilitation is the effective long-term solution. Changing the forces on the front of the foot means improving flexibility, toning the muscles of the abdomen, hip, and back. It also means learning a different way of walking and standing.
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