Despite being a relatively unknown condition, one out of three people will suffer from Morton’s Neuroma. A neuroma is a benign growth or tumor that arises from a nerve. There are different types, depending on where they are found e.g., acoustical neuromas are on the vestibular nerve affecting hearing and balance. But “neuroma” is slightly misleading since they aren’t an actual growth or tumor. They are actually the existing tissue around the nerve that becomes inflamed and causes fibrotic changes, or scarring, on the nerve that increases over time.
Causes
*The space between the metatarsals, or long bones in the foot is narrower between the 2nd and 3rd and the 3rd and 4th bones. As a result, this anatomical issue alone compresses and irritates the nerves in these areas when we walk and stand.
* Anything that chronically stresses and irritates the plantar digital nerve (as discussed below), causing it to be compressed, constantly rubbed, traumatized or stretched produces further swelling and inflammation. Over time this can cause a thickening or fibrosis (scarring) to form on the nerve.
Factors that exacerbate Morton’s Neuroma
*Those who have extremes in their foot arch- either high or flat. Both create biomechanical deformities that can bring on instabilities around the toe joints that encourage the formation of neuromas.
*Trauma that damages or inflames the nerve can create a site where further irritation, rubbing or compression can lead to neuromas.
*Improper fitting shoes that cause the toes to be squeezed together. Because of women’s fashion encouraging high-heeled, pointy toed shoes, females have four times the incidence of getting a Morton’s neuroma (read how shoes impact pain). Anything higher than two inches increases pressure in the forefoot area.
*Repeated stress, particularly from certain actives such as ballet or skiing in tight shoes that compress the toes or professions that require long hours of standing or walking. Or high impact sports such as running. Try alternating with low impact workouts like walking, swimming, or yoga to lessen the toll on your feet.
*Increased weight puts added stress and strain on our feet and increases the risk of inflaming tendons. According to the American College of Foot and Ankle surgeons, every pound above your ideal weight adds eight pounds of stress to the ankle and foot soft tissues, bones and joints.
*Anything that changes the normal anatomy of the foot like bunions or hammertoes changes the biomechanics of the foot and how weight is distributed.
*Those who have underlying medical issues that already affect the feet- diabetes, neuropathy, gout, or altered gait.
Symptoms
*Numbness or tingling between the toes, the ball of the foot or the toes themselves.
*The feeling there’s something stuck in your shoe, like a pebble or lump in the ball of your foot, when you stand or walk.
*A palpable mass at the site of pain.
*Sharp, stabbing or burning pain in the ball of the foot or toes.
*Feeling the pain more when you push off from the toes as opposed to the heel or arch.
*Swelling between the toes.
Diagnosis
They are most commonly found between the 3rd and 4th toes, and to a lesser extent between the 2nd and 3rd toes. It’s rare to have more than one foot involved and even more rare to have two neuromas on the same foot. The highest prevalence is found between the ages of 15-50.
* A careful examination is done to assess if a mass is palpable at the site of the pain and reproduces or exacerbates the symptoms when triggered.
*Is the site of the pain consistent with a Morton’s neuroma? If not, other etiologies may be the answer to your pain.
*An Xray won’t reveal a neuroma, but it will rule out any other etiologies such as arthritis or a stress fracture.
*An MRI- magnetic resonance imaging- is great at detecting soft tissue abnormalities such as neuromas,
*An ultrasound is inexpensive and can identify a neuroma with similar accuracy to an MRI without the cost or exposure to radiation.
*EMG- electromyelographic study that tests the electrical activity of nerves and muscles.
Prevention
*Make sure your toes have plenty of room and aren’t compressed when you walk and stand. If you’re unclear what shoe size accomplishes this goal, seek an expert opinion.
*Stay away from heels higher than two inches. Shoes have a significant effect on pain by changing the biomechanics of the feet, legs and lower back when we stand and walk.
*Maintain a healthy weight. The higher our weight the more stress our feet have to bear. But not only that, weight itself can increase and distort the normal anatomy of the foot.
*Wear loose socks. Too often we forget the impact socks alone can have on our feet. When too tight they put pressure on the toes and restrict movement.
*Wear shoes with plenty of padding to cushion the balls of your feet and lessen the impact on that area of the foot with extended periods of walking or standing.
*Take a few moments every few hours to ice, massage and rest the feet in professions that have to stand or walk all day.
*Change sports venues to soft surfaces like grass, soft sand, as opposed to rock hard ones. This is especially true for joggers who run on asphalt roads.
*Enhance the foots biomechanics by adding a good arch support to your shoes or padding to the ball of the foot.
Seek medical help when the pain persists, worsens or interferes with daily activities.
Tune in next week for home remedies and medical treatments.
