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What is that pain in your foot? Is it Morton’s neuroma?

Discussion in 'Articles' started by mark6622, Apr 9, 2014.

  1. mark6622

    mark6622 New Member

    If you’ve ever had the feeling of walking around with a rock in your shoe, then you might understand the first symptoms of Morton’s neuroma. Often, this condition causes you to feel as if a rock is stuck in your shoe, your sock is bunched up, or something is poking you in the ball of the foot.

    Many people will have different experiences of Morton’s neuroma pain. To some, it will feel like they are walking on a twisted bit of sock, and some express pain when walking over a hardwood floor barefoot. Cramping, numbness, and burning are often reported, and the pain may radiate to other toes than the third and fourth ones.

    The pain is generally worse when wearing shoes or with activity, and this is when it creates the feeling of a rock in the shoe. In addition, you may feel numbness and tingling in the toes as the condition affects the sensory facilities of the nerve in the foot.

    In addition, the episodes of pain can be intermittent. You may experience flare-ups such as two attacks in a week, but then have no symptoms for over a month. However, the attacks tend to become more frequent as time progresses, and this will probably lead you to seek treatment. Rarely, a foot may contain two separate Morton’s neuromas, but this is not common.

    What is it?

    Although the word neuroma can conjure up images of cancer, Morton’s neuroma is not a cancerous tumor. It is a thickening of the tissue surrounding a nerve that supplies sensation to the upper half of the foot. It starts when the nerve that runs under the ligament between the metatarsals, or toe bones is squeezed, like when you wear a shoe that is too narrow for long periods of time. The nerve sheath becomes irritated and thickens. Once started, the thickening can progress and enlargen. Usually, it occurs in the ball of the foot between the third and fourth toes, but it can occur between other toes in the ball of the foot as well. In general, Morton’s neuroma does not indicate any serious pathology of the foot. It is common and treatable.

    How is it diagnosed?

    Care must be taken in diagnosing Morton’s neuroma. In some cases, nerve pathology of the entire foot can be missed because the examiner mistakenly thinks that the problem is Morton’s neuroma. For this reason, it is important to see an experienced practitioner who takes a careful history followed by an in depth physical examination. Although the doctor may not feel a lump, if it is painful when the doctor presses on the space between the third web, then Morton’s neuroma is a likely diagnosis.

    X-rays of the foot will not show Morton’s neuromas, so it is often necessary to turn to other diagnostic measures to help diagnose the condition. Magnetic resonance imaging, or MRI, is a sensitive test for diagnosing Morton’s neuroma. MRI’s can also help determine if the pain is caused by other foot problems, such as a ganglion cyst or cancerous neuroma of the foot. In addition to MRI’s, an ultrasound of the foot can be as effective as an MRI in the diagnosis of Morton’s neuroma.

    Another way to determine if the pain is caused by Morton’s neuroma is through a diagnostic injection of a local anesthetic, usually lidocaine. The medication is injected directly into the nerve that serves the affected web space generally between the third and fourth toes. If the pain is eliminated by blocking this nerve, then a diagnosis of Morton’s neuroma is likely. However, if the block fails to relieve the pain, then it is more likely that the pain is caused by a different condition. This diagnostic procedure is helpful when more than one web space is experiencing pain, and it is often as definitive as other tests when the pain is diffuse.

    Once diagnosed, Morton’s can be effectively treated. In the early stages, it may be treated conservatively with a combination of rest, physical therapy and wearing correctly fitted shoes with orthotics. If the Morton’s neuroma progresses you have the option of a variety of procedures done under radiological or ultrasound guidance. The use of ultrasound guidance for the procedures increases the likelihood of success and decreases the chances of any complications. Recent studies have shown excellent results for the treatment of Morton's neuroma with ultrasound guided steroid injections, ultrasound guided sclerosing injections, ultrasound guided radiofrequency ablation, and ultrasound guided cyroablation. A physician experienced in treating Morton’s neuroma should work with you to create a treatment plan that is appropriate for you.

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