Morton’s Neuroma

Answer, provided by William R. Olson, DPM, President, AAPSM 1999 - 2000

Q: I have been told that I have a Morton's neuroma. What is it, and how is it treated?

A: Traumatic neuromas or, as they are commonly called, Morton's neuromas, are one of the more common problems seen by a foot specialist. A Morton's neuroma is an inflamed and/or enlarged nerve which most commonly occurs between the 3rd and 4th metatarsal heads and slightly less commonly between the 2nd and 3rd metatarsal heads. Symptoms are usually that of intermittent pain, with occasional numbness and tingling radiating back into the foot or out into the affected toes. In more advanced cases, a clicking may be felt as the enlarged nerve slips over a ligament that is present in this area and may cause complete numbness to the toes which this nerve innervates. This disorder is aggravated by shoes that are too tight, high-heeled shoes, or biomechanic imbalances.

This condition is frequently treated successfully with functional foot orthotics which address any abnormal biomechanics that contribute to the trauma to this nerve and, if properly fabricated, can effectively lift and separate the metatarsals, thereby relieving pressure on the nerve. In those cases which do not satisfactorily respond to orthotic treatment, corticosteroid injections are administered up to a maximum of approximately three times. Finally, in the recalcitrant cases, surgery is recommended where removal of the neuroma is performed. This is generally performed under a local anesthetic, and the patient is required to minimize weightbearing and ambulation for four to six weeks after surgery. The results of the surgery are generally quite excellent. However, numbness between the affected toes is to be expected, as the nerve which innervates this area is being removed.

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