Do you ever feel like you are walking or standing on a pebble that doesn’t go away? Do your socks always feel like they are bunching up under the ball of your foot? Aerosmith front man, Steven Tyler did until he was recently diagnosed with a Morton’s neuroma and had it surgically removed. A Morton’s neuroma is a benign swelling of a plantar nerve in the foot. Most commonly affected are the branches between the 2nd/3rd or the 3rd/4th toes. Less common are swellings between the 1st (big toe) /2nd or the 4th/5th toes. Contrary to its name, a neuroma is no longer considered a tumorous growth but rather a fibrous overgrowth of the nerve covering or sheath.
The condition is caused by prolonged irritation or compression of the nerve which occurs with certain foot structures or with repetitive activities like running. The symptoms are pain with weight bearing or a sensation of walking on a pebble. The nature of the pain can vary from person to person and has been described as burning, tingling and shooting. Patients sometimes complain of numbness to the toes. Symptoms begin gradually, occurring with particular types of activities or shoe wear and progress over time leading to potentially permanent changes.
Diagnosis of a neuroma is made through thorough clinical examination and history of symptoms. Evaluation is best early in order to increase the success of conservative care. Imaging modalities such as ultrasound (US) or magnetic resonance imaging (MRI) help aid the physician in identifying to inflamed nerve, exclude other potential causes and even guide treatment. X-ray images will not show a neuroma but are useful in excluding potential causes such as metatarsal stress fractures or arthritis.
Treatment is best when started early. Early on treatment is conservative with shoe inserts or orthotics and activity modification. More frequently medications are needed in the form of oral non-steroidal anti-inflammatory drugs (NSAIDs) to reduce the inflammatory response caused by irritation/compression of the nerve. More resistant cases are treated with a series of corticosteroid injections or sclerosing alcohol injections. When conservative treatment options fail to provide relief, surgical removal of a segment of the nerve is warranted. Surgery is a simple day procedure with an average recovery time of 3-4 weeks.
If you are concerned that you have signs and symptoms of a neuroma call us at North Texas Foot & Ankle (972-574-9255) for a consultation.