Females at Risk for Painful Neuromas

A Morton's Neuroma is a benign (noncancerous) swelling along a nerve in the foot that carries sensations from the toes.

The reason the nerve starts to swell is unknown. But once swelling begins, 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. A Morton's neuroma also is called an interdigital neuroma, intermetatarsal neuroma or a 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 also is rare for a Morton's neuroma to develop in both feet at the same time. The condition is much more common in women than men, probably as a result of wearing high-heeled, narrow-toed shoes. This style of shoe tends to shift the bones of the feet into an abnormal position, which increases the risk that a neuroma will form. Being overweight also increases the risk of a Morton's neuroma.

Symptoms

Typically, there's no outward sign of this condition, such as a lump. Instead, you may experience the following symptoms:

• A feeling as if you're standing on a pebble in your shoe
• A burning pain in the ball of your foot that may radiate into your toes
• Tingling or numbness in your toes

When to see a doctor

It's best not to ignore any foot pain that lasts longer than a few days. See your doctor if you experience a burning pain in the ball of your foot that's not improving, despite changing your footwear and modifying activities that may cause stress to your foot.

Causes

Morton's neuroma seems to occur in response to irritation, pressure or injury to one of the nerves that lead to your toes.

Risk factors

Factors that appear to contribute to Morton's neuroma include:

• High heels. Wearing high-heeled shoes or shoes that are tight or ill fitting can place extra pressure on your toes and the ball of your foot.
  
• Certain sports. Participating in high-impact athletic activities such as jogging or running may subject your feet to repetitive trauma. Sports that feature tight shoes, such as snow skiing or rock climbing, can put pressure on your toes.
  
• Foot deformities. People who have bunions, hammertoes, high arches or flatfeet are at higher risk of developing Morton's neuroma.

Diagnosis

During the exam, your doctor will press on your foot to feel for a mass or tender spot. There may also be a feeling of "clicking" between the bones of your foot.

Imaging tests

Some imaging tests are more useful than others in the diagnosis of Morton's neuroma:

• X-rays. Your doctor is likely to order X-rays of your foot, to rule out other causes of your pain — such as a stress fracture.
  
• Ultrasound. This technology uses sound waves to create real-time images of internal structures. Ultrasound is particularly good at revealing soft tissue abnormalities, such as neuromas.
  
• Magnetic resonance imaging (MRI). Using radio waves and a strong magnetic field, an MRI also is good at visualizing soft tissues. But it's an expensive test and often indicates neuromas in people who have no symptoms.

Treatment

Treatment depends on the severity of your symptoms. Your doctor will likely recommend trying conservative approaches first.

Therapy

Arch supports and foot pads fit inside your shoe and help reduce pressure on the nerve. These can be purchased over-the-counter, or your doctor may prescribe a custom-made, individually designed shoe insert — molded to fit the exact contours of your foot.

Surgical and other procedures

If conservative treatments haven't helped, your doctor might suggest:

• Injections. Some people are helped by the injection of steroids into the painful area.
  
• Decompression surgery. In some cases, surgeons can relieve the pressure on the nerve by cutting nearby structures, such as the ligament that binds together some of the bones in the front of the foot.
  
• Removal of the nerve. Surgical removal of the growth may be necessary if other treatments fail to provide pain relief. Although surgery is usually successful, the procedure can result in permanent numbness in the affected toes.

Source: mayoclinic

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