Neuroma

Morton??s neuroma is a condition that affects one of the nerves that run between the third and fourth toes that may at first appear gradually, but becomes more significant and persistent over time. The exact cause is not certain, as there are a number of things that are thought to contribute to this condition. Symptoms can range from pain that starts in the ball of the foot and shoot into the affected toes, to a burning or tingling sensation of the toes. The treatment of this condition varies widely and includes conservative and surgical treatments, depending on the physician. This paper will examine the different causes and symptoms of a neuroma, as well as the different treatment options and recovery period.















Morton??s Neuroma

What is Morton??s Neuroma?
A neuroma is an enlargement of nerve tissue that occurs at the base of the third and fourth toes that causes pain and numbness in the affected area. The tissue or ligament around the nerve swells up, which causes a pinching of the nerve and results in a sharp burning sensation in the toes. It is sometimes referred to as an intermetatarsal neuroma, which describes its location, and occurs in the ball of the foot between the metatarsal bones (the bones extending from the toes to the midfoot). It is sometimes referred to as a benign growth, or tumor, of nerve tissue that leads to the thickening of the toes, and a sharp burning pain in the ball of the foot. The irritation of the nerve could eventually lead to permanent nerve damage that may require patients to take painkillers, have steroid injections, or eventually surgery to either remove the nerve or release the ligament around it. This condition was first described by T.G. Morton in 1876. He used a more vague terminology of ??metatarsalgia?? which described it as a painful condition in the ball of the foot (Bennett).
What are the causes of Morton??s neuroma?
Doctors are not sure what exactly causes Morton??s neuroma, but it seems to develop as a result of an irritation, pressure or an injury to one of the nerves that lead to the toes. One of the most common offenders is wearing shoes that are too narrow or tapered around the toes, or high heeled shoes that force the toes into the narrow part of the shoe. Because the anatomy of the bones in the feet is narrow between the metatarsals, the nerves that run between these are more likely to be compressed or irritated from wearing these types of shoes. People that have certain deformities in their feet, such as bunions or hammertoes which cause the bones to pinch the nerves, are at a higher risk for developing a neuroma. Other potential causes are activities that involve a repeated irritation to the foot, such as running, court type sports, or stress from long periods of standing on the feet. Also, inflammation in the joints or ligaments in the foot next to the nerves can cause irritation that lead to a neuroma. Improper footwear can cause the toes to be squeezed together that can be problematic.
What are the symptoms of Morton??s neuroma?
The symptoms of Morton??s neuroma can occur unexpectedly and get progressively worse over time. You may have one or more of these symptoms:
?X Tingling, numbness, or burning sensation in the toes or foot
?X Pain in the ball of the foot when weight is placed on it
?X A feeling that something is inside the ball of the foot
?X Swelling between the toes
At first the symptoms begin gradually, and then may go away temporarily by removing the shoe and massaging the foot. When wearing narrow-toed shoes or by performing activities that aggravate the foot, the symptoms become more intense as the neuroma enlarges and the damage to the nerve becomes permanent (American). Over time the symptoms progressively worsen and may persist for several days or weeks.
How physicians diagnose a Morton??s neuroma?
To diagnose a neuroma, a podiatrist (foot specialist doctor) will obtain a thorough history of your symptoms, and will examine the foot and try to locate the affected nerve. This can be done by manipulating the foot and toes in trying to reproduce the symptoms. X-rays are also taken of the foot to make sure the pain is not coming from a broken bone. The doctor will ask the patient to describe the pain and where it??s located, the intensity, when the symptoms started,