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Contact ACFAOM at:
info@acfaom.org
ACFAOM
5272 River Road, Suite 630
Bethesda, MD 20816
800-265-8263
301-718-6505
Fax: 301-656-0989
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Morton's Neuroma, or Intermetatarsal Neuroma
What to look for:
Feelings of numbness, tingling or tenderness in the ball of the foot (the area just behind the base of the toes) are some of the first signs of a condition known as Morton's Neuroma. However, the condition is somewhat unpredictable, and symptoms may vary from patient to patient. Generally, however, the discomfort gets worse rather than better, and the patient may feel pain or a burning sensation that radiates out to the toes. Eventually, wearing shoes becomes uncomfortable (or even unbearable), and the patient may complain that the feeling is similar to that of having a stone bruise, or walking on a marble or pebble constantly, even though no there is no trauma to the skin, and no visible bump or lump on the sole of the foot.
Other notes:
Neuroma patients occasionally complain of a "pins and needles" sensation that spreads through their feet, or of a feeling akin to hitting their "funny bone." The sensation may be described as similar to an electric shock. Some patients also say that these symptoms, as well as those listed above, will come and go, depending on what they are wearing on their feet, the activity they are doing, or on other external factors.
What it means to you:
If you're repeatedly tempted to remove your shoe and look for the stone that is digging into the ball of your foot, you should probably go ahead and do so. If you find one, great - your problems are over. But if, after several fruitless attempts to shake that pesky pebble out of your shoe, or to find evidence that one was even in there in the first place (if you can't find the discoloration or swelling that would be the hallmarks of a stone bruise, for example), you should see a podiatric physician. Chances are that you have a condition called Morton's Neuroma.
Morton's Neuroma is a thickening of the tissue that surrounds the nerve leading to the toes. When the nerve becomes squeezed and irritated, it causes the painful symptoms.
Who is susceptible?
Podiatric physicians report that the vast majority (almost 90%) of all neuromas are diagnosed in women age 18 - 85, or to be more accurate, in adult women. Some patients report multiple neuromas in the same foot; however, this is the exception, rather than the rule.
What causes it?
Although in many areas of medicine, it's easy to pinpoint the exact source of a problem (the way a specific germ causes a certain illness with recognizable symptoms), neuromas are harder to categorize. While there isn't really one exact cause, podiatric physicians tend to agree that a neuroma can occur in response to the irritation of a nerve by one or more factors:
- Abnormality in foot function or foot mechanics: In other words, a foot that doesn't move the way science thinks it should. In general, this means a pronated foot (one with an excessive rolling motion when the patient is walking, running or doing any kind of activity), because it causes excessive strain on the nerve. If you are not certain whether or not this is a problem for you, ask your podiatric physician, who will be able to examine your feet, as well as the wear pattern on your shoe, and give you an answer. Foot mechanics, and problems with them, tend to run in families, so if you know that a relative has had foot pain similar to yours, be sure to mention it.
There are orthoses and corrective shoes that can effectively alleviate disturbances to foot mechanics. A podiatric physician can prescribe the best corrective footwear and shoe inserts for all activities - work, exercise, play, walking, shopping and more, based on an analysis of the patient's foot and his or her lifestyle.
- Improper footwear: Podiatric physicians have long believed that constricting, narrow, poor-fitting shoes with a tight or pointed toe box tend to compress the end of the foot, leading to abnormal motion of the foot and to excessive pressure in the area of the nerve. High-heeled shoes are a particular culprit here, since they put pressure on the area around wearer's toes and the ball of the foot.
- Occupational hazards: Individuals whose jobs place undue stress on their forefeet (with or without wearing improper footwear) are among those who complain of neuromas. Podiatric physicians report that individuals who work on ladders, or who perform activities on their knees (such as doing landscaping, carpeting, flooring, or other work on the ground) are at risk for this problem, too, since these activities cause stress to the nerve near the ball of the foot.
- Previous trauma to the foot: Those who engage in high-impact activities that bring repetitive trauma to the foot (running, aerobics, etc.) have a better than average chance of developing a neuroma at the site of a previous injury. To put it more simply, if you have sustained a previous injury to your foot (a sprain, stress fracture, etc.), that area of your foot will be more prone to neuroma development than an area that has not been injured. However, sports injuries aren't automatically a ticket to neuromas. Trauma caused by other forms of injury to the foot (dropping heavy objects, for example) can also cause a neuroma to develop at the site of the previous injury.
- Unknown factors: Much though we hate to say it, sometimes neuromas just develop and nobody knows why. The patient doesn't have a previous injury, is wearing properly fitted shoes, and doesn't stress his/her feet with any specific activity - but the neuroma develops anyway.
It is important to remember that some of the factors listed above can work alone, or in combination with each other, to contribute to the formation of neuroma.
How do I know if I have it?
If you suspect Morton's Neuroma, it is essential that you confirm your suspicions by consulting with a podiatric physician. Don't wait for the symptoms to go away for good (even if they tend to come and go). Also, remember that many conditions have similar symptoms, and only a professional can tell the difference.
Your podiatric physician will begin by taking a history of your problem. Assist him or her by describing your condition as well as you can. Keep track of when the symptoms started and how, any changes you've noted (whether the pain has gotten worse, or whether other symptoms have appeared as well, etc.). If you've noticed that certain activities or footwear make things worse or bring about additional symptoms, be sure to mention that. If you work in specific footwear, or if you participate in any certain sports, bring the shoes you use. Your doctor may be able to learn quite a lot about your condition that way!
The doctor will perform an examination of your feet as well. He or she may palpate your feet and flex them in specific ways that will indicate the presence of a neuroma. X-rays are often used to rule out other problems, such as fractures, bone spurs, arthritis or other problems with the bones in the toes or foot. In some cases, an MRI (magnetic resonance imaging) may be helpful to confirm the presence of a neuroma.
What cures it?
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.
Should the problem have progressed beyond the point where these measures are sufficient, the podiatric professional may recommend surgery. This procedure involves excision of the involved nerve mass. This will relieve the pain. Many patients report permanent numbness in the spot formerly affected by the neuroma, but prefer it to the pain. Most surgeries are successful; unfortunately, there are cases where the patient suffers another neuroma, sometimes in or near the same spot as before. A podiatric professional can explain the statistics of recurrence in various cases.
If you suspect a neuroma, don't wait for it to get better on its own. The earlier the diagnosis, the higher the likelihood that it can be treated with conservative measures. Don't think that foot pain of any kind is inevitable, either, even if it runs in your family.
How can neuromas be prevented?
The best way to prevent a neuroma is by avoiding the things that cause them. Review your risk factors. If relatives have had similar problems, or if you know that you pronate or have any problem with the mechanics of your foot, talk with a podiatric physician about the correct types of shoes and/or orthoses for you. If you are not sure whether you have such a problem, the podiatric professional can analyze your foot, your stride and the wear pattern of your shoes, and give you an honest evaluation.
Remember, though, that sometimes neuromas, like other conditions, can develop for no discernible reason. With this in mind, be good to your feet, and be aware of any changes or problems. Don't wait to report them.
Do these symptoms always mean a neuroma?
No - several other problems, such as those previously mentioned - arthritis, stress fractures, etc, which can have symptoms similar to that of a neuroma. That's why it's important to have a professional look at your foot and make a diagnosis. The problem only gets worse the longer treatment is delayed.
Who can help me?
The American College of Foot & Ankle Orthopedics & Medicine (ACFAOM) stands ready to help you find a podiatric physician in your area. Simply click on our foot-help-finder link to find the professional who can help you find the most effective treatment.
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