Neuroma or Morton’s disease is a swelling of the tissue healingaround the nerves of the toes which causes a sharp pain , usually between the 3 rd and the 4 th toe. Pain, similar to a burn , is felt while standing or walking and rarely in both feet at the same time.
Causes of Morton’s disease
The exact cause of Morton’s neuroma is poorly known, but it may be the result of nerve compression of the forefoot due to shoes that are too narrow. It could also be caused by thickening and scarring of the tissue around the nerves that communicate with the toes in response to irritation, pressure or injury.
More rarely, Morton’s neuroma develops between the 2 nd and 3 rd toe. In about 1 in 5 patients, the neuroma appears in both feet .
Morton’s neuroma is a common malaise of the foot and would be more common in women , probably because of the more frequent wearing of high-heeled or narrow shoes.
Diagnostic of Morton’s disease
A medical examination is usually sufficient to establish the diagnosis of Morton’s neuroma. MRI(Magnetic Resonance Imaging) is rarely useful for confirming a diagnosis, it is expensive and may be falsely positive in a third of cases that are asymptomatic.
Symptoms of Morton’s disease
This condition usually has no external sign:
- A sharp pain like a burn in the front of the foot that radiates into the toes. The pain is often maximal at the plantar area and temporarily stops during the removal of the shoes, during the flexion of the toes or the foot massage;
- The feeling of walking on a pebble or having a fold in a sock;
- A tingling or numbness of the toes;
- Symptoms that intensify during prolonged periods of standing or when wearing high-heeled or narrow shoes.
People at risk for Morton’s disease
- People who have deformities of the foot such as onions (bulging joints and soft tissues at the base of the big toe), claw toes (deformed toe joints), flat feet or excessive flexibility;
- People who have excess weight .
- Wearing high heels or tight shoes can put pressure on the toes;
- Practice some athletic sports such as running or jogging that subject feet to repetitive impacts . Practice sports that involve wearing tight shoes that compress toes, such as downhill skiing, ski touring or rock climbing.
It is not always possible to prevent Morton’s neuroma, but the risk of onset and recurrence can be reduced by wearing comfortable shoes with low heels, plenty of toe space and good support for the patient. arch of the foot.
Acupuncture, reflexology or some foot massage techniques may reduce pain in some people with Morton’s neuroma. However, no scientific study has demonstrated the true effects of these therapies.
Medical treatments of Morton’s disease
The earlier Morton’s neuroma is treated, the more effective is the treatment that includes one or more of these options;
- Wearing wider shoes with low heels and rigid soles reduces pressure on the nerve and heals. Avoid high heels or narrow shoes;
- The orthotic harbor helps relieve irritation by lifting and separating the bone in order to reduce pressure on the nerve ;
- Of anti-inflammatory drugs non-steroidal such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn) to relieve pain;
- The application of ice to relieve pain;
- Reducing or stopping activities such as running, aerobics or dancing that put feet under high impact;
- In many cases, cortisone injections can reduce nerve swelling and relieve pain.
These treatments are effective in 80% of cases. If the combination of these treatments is ineffective after 9 to 12 months, surgery may be necessary. One proceeds either to the release of the compressed nerve (neurolysis or decompression surgery) or to the section of a portion of the nerve concerned (neurectomy). The operation is usually done during local anesthesia and requires 4 to 6 weeks of recovery. The surgery gets 80 to 90% success. However, this is an intervention of last resort because, particularly with regard to neurectomy, the section of the nerve can cause permanent numbness of the toes .