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Morton’s Neuroma

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illustration showing mortons neuroma

is an enlarged nerve that usually occurs between the third and fourth toes. The most common symptom is pain in this area. It can be sharp or dull, and is worsened by wearing shoes and by walking. Pain usually is less severe when the foot is not bearing weight. Causes may be tight shoes, high heels, and flat feet.
To diagnose, the podiatrist may try to reproduce the symptoms of pain by trying to squeeze the enlarged nerve. An x-ray should be taken to ensure that there is not a fracture. X-rays also can be used to examine the joints and bone density, ruling out arthritis (particularly rheumatoid arthritis and osteoarthritis). An MRI may be used to ensure that the compression is not caused by a tumor in the foot and also determine the size of the neuroma.

Initial treatment consists of padding and taping to disperse weight away from the neuroma. If the patient has flat feet, an arch support is incorporated. The patient is instructed to wear shoes with wide toe boxes and avoid shoes with high heels. An injection of local anesthetic to relieve pain and a corticosteroid to reduce inflammation may be administered. The patient is advised to return in a week or two to monitor progress. If the pain has been relieved, the neuroma is probably small and caused by the structure of the patient’s foot and the type of shoes the patient wears.

It can be relieved by a custom-fitted orthotic that helps maintain the foot in a better position. Serial (repeated) neurolysis injections have recently been reported to be quite effective if other conservative measures fail. This involves 3-7 injections of local anesthetic with 4% concentration of alcohol. This mixture effectively destroys the neural tissue, relieving the pain without having to surgically remove the enlarged nerve segment. If resolution is not accomplished via these methods, then surgical intervention to remove the inflamed nerve and possible release of the intermetatarsal ligament would be necessary.