Morton Neuromas: Symptoms, Causes, and Treatment-by Dr. Joseph E. Mechanik

Morton Neuromas: Understanding Causes and Exploring Treatment Options with Care and Expertise

Morton neuromas are a common but often misunderstood foot condition. Despite their prevalence, many people are unfamiliar with the causes, symptoms, and treatment options for this painful ailment. This blog post aims to enhance your understanding of Morton neuromas, provide expert advice on care and treatment, and offer tips on how to prevent this condition from occurring in the first place. By gaining knowledge about Morton neuromas, you can take charge of your foot health and enjoy a more active and pain-free lifestyle.

 Introduction to Morton Neuromas

Morton neuromas are a noncancerous growth of nerve tissue that develops in the foot, most commonly between the third and fourth toes. This thickening of the tissue around the nerves can lead to irritation and compression, which in turn causes the classic burning, pain, and tingling in toes associated with this condition. The sensation of a Morton neuroma has been described as feeling like a mass, a rock, or stepping on something. It's important to remember that a Morton neuroma is not a tumor; rather, it's a benign growth that can often be managed with appropriate care and treatment.

There are several factors believed to contribute to the development of Morton neuromas, including the wearing of tight or high-heeled shoes, foot deformities such as bunions, and repetitive stress or overuse injuries.  The condition is more common in women, likely due to the frequent wearing of high heels and other shoes that place excessive pressure and compression on the forefoot. By understanding the causes and risk factors associated with Morton neuromas, you can take steps to prevent the condition or seek early intervention if you begin to experience symptoms.

Causes of Morton Neuromas

The exact cause of Morton neuromas is not completely understood, but there are several factors that seem to play a role in the development of this condition. One of the primary factors is the wearing of tight, narrow, or high-heeled shoes, which can compress and irritate the nerves in the forefoot. This repetitive irritation can lead to the thickening and growth of nerve tissue, eventually resulting in a Morton neuroma. One of the most common causes of a Morton's Neuroma  is known as biomechanical imbalance which leads to mis-alignment and imbalance of the foot which can create compression of the nerve in your foot; genetically inherited foot structures.

Additionally, certain foot deformities, such as bunions, hammertoes, high arches, or flat feet, can increase the risk of developing Morton neuromas. These deformities, which are caused by foot misalignment and imbalance cause abnormal weight distribution and pressure on the nerves, leading to nerve irritation and the subsequent growth of nerve tissue. Finally, repetitive stress or overuse injuries, such as those that occur during high-impact sports and activities, can also contribute to the development of Morton neuromas. Repetitive High-intensity interval training (HIIT)  activities. By recognizing these factors, you can take steps to minimize your risk and seek early intervention if you begin to experience symptoms.

Symptoms of Morton Neuromas

1. Burning sensation: One of the most common symptoms of a Morton neuroma is a burning pain in the ball of the foot, which may radiate to the toes. This burning sensation is often exacerbated by wearing tight or high-heeled shoes and can be relieved by removing the shoes and massaging the affected area.
2. Tingling and numbness: Some individuals with Morton neuromas also experience tingling, numbness, or a pins-and-needles sensation in the toes. This can be particularly bothersome when walking or standing for extended periods.
3. Feels like stepping on something: Another characteristic symptom of a Morton neuroma is the sensation that you are stepping on a mass, a rock, or something else inside your shoe. This feeling is typically more pronounced when wearing tight or narrow shoes that place additional pressure on the affected area.

 Diagnosis of Morton Neuromas

 Medical history and physical examination

When diagnosing Morton neuromas, Dr. Joseph Mechanik or your podiatrist will begin by taking a thorough medical history and conducting a physical examination of the affected foot. This will typically involve palpating the area between the toes to check for tenderness or a mass-like feeling.

Imaging tests

Imaging tests, such as X-rays, ultrasounds, or MRIs, may also be ordered to help confirm the diagnosis and rule out other potential causes of the patient's symptoms, such as stress fractures or arthritis.

Weight-bearing tests

In some cases, a healthcare provider may perform weight-bearing tests, such as having the patient stand on their tiptoes or apply pressure to the affected area, to further assess the severity of the neuroma and determine the most appropriate course of treatment.

Care and Expertise in Treatment

When it comes to treating Morton neuromas, seeking care and expertise from a qualified healthcare professional is essential. If you have a neuroma, you need to see a board-certified podiatrist like Dr. Joseph E. Mechanik. Podiatrists are the foot specialists, and they can diagnose and treat neuromas effectively. If you don't see a podiatrist, your neuroma could get worse. The appropriate treatment plan will depend on the severity of your symptoms and your individual needs. In many cases, conservative treatments, such as changes in footwear, padding and prescription orthotics, and physical therapy, may be sufficient to alleviate pain and discomfort. Additional conservative modalities that will work and are often prescribed are NSAID therapy, MLS laser therapy, platelet rich plasma injections, corticosteroid injections, fracture boots, immobilization and nonweightbearing However, in more severe cases or when conservative treatments are ineffective, surgical intervention may be necessary to achieve lasting relief.  The majority of patients with neuromas can get relief and resolve their pain through conservative treatment modalities.

Conservative Treatments for Morton Neuromas

1. Footwear modifications: Wearing shoes with a wide toe box and low heels can help alleviate pressure on the affected area and provide relief from symptoms.  Supportive shoes with non-constricting toe boxes.
2.  Prescription orthotics-custom shoe inserts work to redistribute pressure on the foot, reducing irritation of the affected nerve.  Over-the-counter arch supports are recommended only to try and see if some support with the arch support helps.  If an over-the-counter arch support is helpful, you should seek to get prescription orthotics fabricated and calibrated specifically to your feet.
3. Physical therapy and at-home exercises: Strengthening and stretching exercises, as well as massage and ice therapy, can help improve foot function and alleviate pain caused by Morton neuromas.

4.  A steroid injection can help a neuroma by reducing inflammation and pain.

5. Nonsteroidal anti-inflammatory medications (NSAIDs) and steroids can help reduce inflammation and pain caused by neuromas.

6. Platelet-rich plasma (PRP) can help neuroma pain by stimulating the body's natural healing process.

7. MLS laser therapy can help Morton neuromas by reducing inflammation and pain, and stimulating tissue regeneration.

8. A B-12 injection can help a neuroma of the foot by promoting nerve regeneration and diminishing pain from nerve damage.

 Surgical Treatments for Morton Neuromas

Surgical treatment for Morton neuroma should be only be  considered only after multiple conservative treatments have failed to provide relief.  In cases where conservative treatments are unsuccessful in providing relief, surgical intervention may be necessary. There are two primary surgical options for treating Morton neuromas: decompression surgery and neurectomy (removal of the neuroma mass). Decompression surgery involves releasing the tight ligaments or other structures compressing the affected nerve, while neurectomy involves removing the thickened nerve tissue itself. surgical decompression of a neuroma may not work, if the nerve is scarred and damaged.  This is why it is important to have an advanced imaging study such as an MRI.  This allows the surgeon to assess the size of the neuroma and decide if a decompression of excision would be recommended.  

Surgery for Morton neuromas typically  have high success rate in providing relief from symptoms, but as with any surgical procedure, there are risks and potential complications. Working with an experienced board-certified podiatrist/podiatric surgeon and following their post-operative care instructions can help minimize these risks and promote a successful recovery.

Complications that can happen with Morton neuroma surgery on the foot:

• Infection: This is the most common complication, and it can occur in up to 5% of cases. Infections can be treated with antibiotics, but they can sometimes lead to more serious complications, such as sepsis.
• Nerve damage: This can occur if the nerve is not properly identified or removed during surgery. Nerve damage can cause numbness, tingling, and weakness in the affected foot.
• Regrowth of the neuroma: This is a rare complication, but it can happen if the entire neuroma is not removed during surgery.
• Scar tissue formation: This can occur at the surgical site and can make it difficult to wear shoes.
• Bleeding: This is a rare complication, but it can occur if the blood vessels are not properly cauterized during surgery.
• Pain: Pain can persist after surgery, and it may take several months for the pain to fully resolve.
• Hammer toe/Drifting Toe: This can occur if the surgeon cuts a tendon or part of your joint capsule
• Complex regional pain syndrome (CRPS) is a chronic pain condition that can develop after a traumatic injury, such as foot surgery. It is characterized by severe pain, swelling, and changes in skin color and temperature. CRPS is a complex condition that is not fully understood, but it is thought to be caused by changes in the nervous system.

 Prevention of Morton Neuromas

Preventing Morton neuromas from developing or recurring involves addressing the factors that contribute to their formation. Some preventive measures include:

- Wearing properly fitting shoes with a wide toe box and low heels
- Avoiding high heels or shoes that place excessive pressure on the forefoot
- Using custom prescription orthotics to properly align your feet and keep pressure of the forefoot.
- Participating in regular foot exercises to maintain strength and flexibility

-Don't walk around your house barefoot, especially hardwood floors.

By taking these simple steps, you can reduce your risk of developing Morton neuromas and enjoy a more active, pain-free lifestyle.

 Conclusion

Morton neuromas can be a painful and frustrating foot condition, but with proper care and expertise, they can be effectively managed and treated. By understanding the causes, symptoms, and treatment options available, you can take charge of your foot health and work towards a future free of burning, pain, and tingling in your toes. Don't let Morton neuromas hold you back – seek the expert care of Dr. Joseph E. Mechanik, dual board certified podiatrist & podiatric surgeon.