Polly Tindol

Resolving Feet Dilemmas

Managing Mortons Neuroma

Overview

intermetatarsal neuromaMorton's metatarsalgia is a condition associated with a painful neuroma* on the digital nerve causing pain in the foot. Charcterised by perineural fibrosis and nerve degeneration due to repetitive irritation, is thought to be due to irritation of the digital nerve caused by repeated trauma, ischemia or entrapment of the nerve, occurs most frequently in women aged 40-50 who wear high-heeled, pointed-toe shoes. The neuroma occurs at the level of the metatarsal necks. The common digital nerve to the third/fourth metatarsal spaces is most often affected, although other interspaces can be involved.

Causes

The cause of this problem is often due to impingement of the plantar nerve fibres between the metatarsal heads and the intermetatarsal ligament. It is entirely a biomechanical phenomenon. Differential diagnoses include stress fracture, capsulitis, bursitis or ligament injury at the metatarsal-phalangeal joint, a tendon sheath ganglion, foreign-body reaction and nerve-sheath tumour.

Symptoms

A Morton's neuroma causes a "burning" sharp pain and numbness on the bottom of the foot in the involved area, and this pain and numbness can radiate to the nearby toes. The pain is usually increased by walking or when the ball of the foot is squeezed together and decreased with massaging. It may force a person to stop walking or to limp from the pain.

Diagnosis

In some cases your doctor will be able to feel the Morton's as a swelling in the middle of your foot. However they may also suggest an X-ray or a blood test - this is normally to rule our other causes of the pain such as arthritis. The most accurate way to diagnose Morton?s itself is with magnetic resonance imaging (MRI) or ultrasound.

Non Surgical Treatment

It can be helpful to perform deep stripping massage techniques along the length of the tibial nerve and the medial and lateral plantar nerves. After properly mobilizing these tissues, moving the foot and toes through a full range of motion to make sure the nerve can move freely will also be helpful. Foot pain like that occurring in Morton's neuroma, can become a debilitating and painful condition. And while massage can be helpful for this condition, it is also clear that improperly applied massage can aggravate it and make it worse. Consequently it is crucial that we use good clinical reasoning and appropriate evaluation methods to most effectively help these clients.interdigital neuroma

Surgical Treatment

Surgical treatment has provided relief in some cases while poor results and surgical complications have resulted in other cases. It is believed that ligament weakness, as opposed to the pinching of nerves in the foot, may be to blame for recurrent pain in these situations. For reasons which are not fully understood, the incidence of Morton?s Neuroma is 8 to 10 times greater in women than in men.
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