DESCRIPTION

An interdigital neuroma (also known as Morton’s Neuroma) is an irritated, swollen nerve in the ball of the foot, classically described as a pain in the ball of the foot located between the base of the third and fourth toes or second and third toes. The involved nerve is sometimes squeezed and irritated by these adjacent metatarsal heads causing the painful neuroma to develop. This squeezing together of the metatarsal bones is usually a result of: narrow shoes, high heel shoes, injury, or a biomechanical defect of the foot (such as loose ligaments; over-pronation, or aches which are too flat or high). This Morton's neuroma is more commonly a problem in females. High-heeled shoes with cramped pointed tips cause additional pressure and irritation on these nerves in the ball of the foot. Individual complaints for a neuroma vary. Frequently, a burning sensation is experienced in the ball of the foot. Patients also complain of cramping in the foot. A sharp pain is sometimes experienced between the bones (metatarsal heads) at the base of the toes. This pain and sometimes a "feeling of numbness" may involve the corresponding toes that the nerve supplies. Walking in shoes aggravates pain. Often a patient will state there is a relief after removing their shoes. Many patients will massage their foot after removing the shoes. When the neuroma is large, patients complain that they can feel a "clicking" between the affected metatarsals. Less commonly, a patient describes a sensation of "walking on a pebble" because the inflamed, swollen nerve is felt under the ball of the foot.

TREATMENT

Custom molded orthotics can be fabricated that will correct the biomechanical defects of the foot (which may be the cause of why the neuroma formed) and with use of a metatarsal pad or Morton’s extension will help to relieve pressure on the nerve and relieve the pain. Wear wider shoes with a padded innersole. To spread the metatarsals, apply a metatarsal support pad under the arch, just behind the bones of the ball of the foot. You should very quickly get used to the pad. If the pad causes discomfort after a couple of hours, readjust it. Women should wear flat shoes. At night, apply ice to the painful areas (avoid ice directly on the toes) for 10 to 20 minutes. If the cold becomes uncomfortable, remove the ice immediately. Follow this with a gentle massage of the area with a warm lotion. If you can tolerate Advil or Motrin, take one of these as directed. These medications not only reduce pain, but will also decrease the nerve inflammation. An injection of cortisone or other anti-inflammatory directly into the neuroma may be needed. Physical therapy is often very helpful. In some cases surgical removal of the neuroma is required.