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Morton’s Neuroma And The Runner

What is "Morton's neuroma" and what is the best way to treat it?

Answer, provided by Perry H. Julien, D.P.M., Director, American Academy of Podiatric Sports Medicine

Q: I've heard of something called Morton's neuroma. Could this be bothering some members of my running club. They say they have pain between their 3rd and 4th toes and a tingling sensation in that area also.

A: A few runner's in the running club I belong to complain about pain in their 3rd and 4th toes that occurs after jogging for twenty minutes. It is sometimes accompanied by a sensation of pins and needles in the same toes and will improve slightly by removing the shoes and rubbing the front part of the foot. What causes this, and how can it be treated?

These are common symptoms of a condition called Morton's neuroma. A neuroma is a thickening of a nerve, and on the foot this occurs most frequently between the third and fourth metatarsal bones and toes. The nerve coursing between these areas can become inflamed when the metatarsal bones are compressed together such as may occur with tight fitting shoes. It may also be aggravated by overuse micro trauma that occurs in weight-bearing sports and exercise, and by biomechanical asymmetries such as over-pronation of the feet.

The symptoms of a neuroma can include pain on the ball of the foot that may be accompanied by a feeling of "pins and needles" or numbness to the 2nd, 3rd or 4th toes. You can also experience the sensation that your socks are bunching up under your feet.

The initial treatment for a neuroma involves the correction of the causative factors. This can include replacing worn out shoes or purchasing a shoe with a wider toebox to allow more space for the front part of the foot. This applies to your dress or business shoes as well as your athletic shoes. Another form of self treatment involves placing a spacer such as a cotton ball between the affected toes to remove pressure of the nerves. If this is still not effective your podiatrist may recommend a series of injection (NO MORE THAN 3) to help reduce inflammation around the nerve. Other conservative treatment may include the use of metatarsal pads or orthotic devices to control any biomechanical problems such as overpronation.

Finally, if aggressive conservative treatment does not resolve your symptoms, and the pain is causing a modification of your normal activities, surgery may be recommended to remove the inflamed nerve.

As with any other injury, a careful diagnosis is necessary because other problems such as metatarsal stress fractures and metatarsal bursitis can sometimes mimic the symptoms of Morton's neuroma.

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