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Home Health Morton’s neuroma may be cause of toe pain, tingling
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Morton’s neuroma may be cause of toe pain, tingling
Written by Ken Chisholm, RN; BS; CNOR; CRNFA; OPA   
Monday, 13 July 2009 11:54

You say you have pain and tingling between your toes and it feels like you’re

walking on a marble?

 

It might be a Morton’s neuroma causing your grief.

Do you ever get a pain and some tingling in between two of your toes, and it hurts to walk bare foot or with constrictive footwear? Is it an annoying burning pain that just won’t go away? Perhaps you have a Morton’s neuroma.Do you ever get a pain and some tingling in between two of your toes, and it hurts to walk bare foot or with constrictive footwear? Is it an annoying burning pain that just won’t go away? Perhaps you have a Morton’s neuroma.

So, just what is a Morton’s neuroma anyway, and how did it get in my foot?

Morton’s Neuroma is described as a condition in which there is irritation, enlargement and swelling of the digital nerves that supply the toes as it passes through ligaments that connect adjoining metatarsals (inter-metatarsal ligaments). This condition typically affects the digital nerve supplying the inner aspects of the third and fourth toes.

As the digital nerve becomes increasingly irritated, it develops a thickened area similar to a nodule or mass (although it is not a tumor). With this comes added pressure from the inter-metatarsal ligaments and metatarsal heads…and the cycle goes on.

Symptoms associated with Morton’s neuroma can include pain and burning sensations, a feeling of “walking on marbles” and frequent episodes of uncomfortable numbness and tingling between the toes. They can come and go, or become more persistent in active individuals such as runners. Aggravating factors include tight-fitting or narrow-width shoes, heels. The condition can begin with intermittent pain and burning, which is relieved by removing shoes and massaging the foot, to constant, unrelenting pain with burning numbness.

Since there are no external characteristics of this neuroma, diagnosis is typically made by way of a physical examination, together with patient history. One diagnostic tool used frequently is called the “compression test.” The test consists of holding the foot and literally “squeezing” the metatarsal heads together, causing them to impinge and press upon the aggravated nerve branches. If sufficient swelling and thickening of the nerve are present, this test can be exceptionally uncomfortable.

So, how is it treated?

Treatment can come in various levels, beginning with oral analgesics, anti-inflammatory drugs and loose-fitting, wider-width footwear. Gentle massaging of the foot can also bring some temporary relief.

As symptoms become more chronic and severe, cortisone injections around the angry nerve can substantially reduce inflammation and swelling. In fact, these injections have long been a mainstay in the treatment of Morton’s neuroma.

So, what happens when these treatment options no longer bring relief?

Well, if it gets to this point, treatment option is the surgical removal of the inflamed, swollen and enlarged portion of the digital nerve. The nerve can’t hurt if it isn’t there, right?

If it comes down to surgery, you need to know a few things before proceeding. First, excising part of the nerve means that a portion of one or both toes will become numb on a permanent basis. As bad as that may sound, many people opt for the numbness over the nagging burning pain.

Second, there is always a chance that another neuroma can re-form.

Third, there is a statistical chance that, unless it is verified by intra-operative pathology examination, the nerve can be missed altogether.

One technique used to lessen the chances of recurrence is by creating a small hole in the far end of one of the metatarsal bones, and inserting the remaining “stump” of nerve tissue into the canal. That way, if there is any element of re-growth, the nerve will be contained within the bone of the metatarsal and not be subject to painful recurrence.

So, if your foot hurts and your toes burn, and you feel like there is a garbanzo bean inside your foot, think Morton’s neuroma and get it checked out.

Chisholm’s expertise in nursing, orthopedics and surgery spans more than 30 years. He holds multiple national certifications in these specialties. His goal is to empowering people through education and information to become more engaged, proactive and responsible in their orthopedic health, and health care.

 
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