Morton?s neuroma occurs as the nerve passes under the ligament connecting the toe bones (metatarsals) in the forefoot. Morton?s neuroma most frequently develops between the third and fourth toes, usually in response to irritation, trauma or excessive pressure. The incidence of Morton?s neuroma is 8 to 10 times greater in women than in men.
The source of this pain is an enlargment of the sheath of an intermetatarsal nerve in the foot. This usually occurs in the third intermetatarsal space, the space between the third and fourth toes and metatarsals. It occurs here, at the site third intermetatarsal nerve, since this intermetatarsal nerve is the thickest being comprised of the joining of two different nerves. It also may occur in the other intermetatarsal areas, with the second interspace being the next most common location.
The most common symptom of Morton’s neuroma is localized pain in the interspace between the third and fourth toes. 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.
Patients with classic Morton?s neuroma symptoms will have pain with pressure at the base of the involved toes (either between the 2nd and 3rd toes, or between the 3rd and 4th toes). In addition, squeezing the front of the foot together can exacerbate symptoms. As well, they may have numbness on the sides of one toe and the adjacent toe as this corresponds with the distribution of the involved nerve.
Non Surgical Treatment
If symptoms are severe or persistent and self-help measures did not help, the doctor may recommend corticosteroid injections, a steroid medication that reduces inflammation and pain is injected into the area of the neuroma. Only a limited number of injections are advised, otherwise the risk of undesirable side effects increases, including hypertension (high blood pressure) and weight gain. Alcohol sclerosing injections, studies have shown that alcohol injections reduce the size of Morton’s neuromas as well as alleviating pain. This is a fairly new therapy and may not be available everywhere. The doctor injects alcohol in the area of the neuroma to help sclerose (harden) the nerve and relieve pain. Injections are typically administered every 7 to 10 days. For maximum relief 4 to 7 injections are usually needed.
Surgery to remove the neuroma may be recommended if more conservative treatment does not solve the problem. While surgery usually relieves or completely removes the symptoms, it often leaves a permanent numb feeling at the site of the neuroma.