Some sources claim that entrapment of the plantar nerve because of compression between the metatarsal heads, as originally proposed by Morton, is highly unlikely, because the plantar nerve is on the plantar side of the transverse metatarsal ligament and thus does not come in contact with the metatarsal heads. It is more likely that the transverse metatarsal ligament is the cause of the entrapment. Despite the name, the condition was first correctly described by a chiropodist named Durlacher, and although it is labeled a “neuroma”, many sources do not consider it a true tumor, but rather a perineural fibroma (fibrous tissue formation around nerve tissue).
Morton’s neuroma may be the result of irritation, pressure or injury. In some cases its cause is unknown. In the majority of cases only one nerve is affected. Having both feet affected is extremely rare. A high percentage of patients with Morton’s neuroma are women who wear high-heeled or narrow shoes. Patients with Morton’s neuroma may need to change their footwear, take painkillers or steroid injections, while others may require surgery to either remove the affected nerve or release the pressure on it.
Many patients describe the sensation as a burning pain in the ball of the foot that often radiates to the toes. Initially, the pain may become much more apparent when the person wears tight, narrow or high-heeled shoes, or engages in activities which place pressure on the foot. Eventually, symptoms may be continuous and last for days, and even weeks. MRI (magnetic resonance imaging) scans have revealed Morton’s neuroma lesions in patients who had no symptoms at all. Symptoms can become so disrupting that many affected individuals become anxious about walking, or even placing their foot on the ground.
Morton’s neuroma is usually diagnosed by your doctor listening to your symptoms and examining your foot. Sometimes your doctor can feel the ‘neuroma’, or an area of thickening in your foot, which may be tender. Sometimes, your doctor may suggest an ultrasound scan or MRI scan to confirm the diagnosis but this is not always necessary. Some doctors inject a local anaesthetic into the area where you are experiencing pain. If this causes temporary relief of pain, burning and tingling, it can sometimes help to confirm the diagnosis and show the doctor where the problem is.
Non Surgical Treatment
Once a diagnosis is obtained, it is essential to begin treatment immediately. Your podiatric physician will advise you on the most effective means. If caught early enough, good foot care, shoes that fit properly, and/or orthoses may eliminate the need for any further intervention. Other conservative measures might include oral non-steroidal anti-inflammatory medication (NSAIDS), physical therapy, ultrasound or other non-invasive measures. If that doesn?t work, your podiatric physician might use injectable steroids, and/or a local anesthetic around the neuroma to reduce inflammation and pain. Many patients report relief after these measures are taken.
Surgery. This is the last and most permanent course of action. This surgery is used as a last resort as it often comes with a series of side affects including the risk of making the pain worse. This surgery can be performed by Orthopedic surgeons as well as Podiatric surgeons.