Managing Mortons Neuroma

Overview

plantar neuromaMorton’s Neuroma is a common foot problem associated with pain, swelling and/or an inflammation of a nerve, usually at the ball-of-the-foot between the 3rd and 4th toes. Symptoms of this condition include sharp pain, burning, and even a lack of feeling in the affected area. Morton’s Neuroma may also cause numbness, tingling, or cramping in the forefoot.

Causes

There are a number of common causes for Morton?s Neuroma, (though the condition can arise spontaneously for reasons still unknown). The Neuroma often occurs in response to irritation, pressure or traumatic injury to one of the digital nerves leading to the toes. A thickening of nerve tissue results as part of the body?s response to the irritation or injury. Abnormal foot movement used to compensate for bunions, hammertoes, flatfeet and other conditions can lead to irritation and development of Morton?s Neuroma. Pronation of the foot may cause the heads of the metatarsal bones to rotate slightly, thereby pinching the nerve running between the metatarsal heads. Chronic pressure or pinching causes the nerve sheath to enlarge, becoming increasingly squeezed, producing worsening pain over time, if not addressed. Morton?s Neuroma can be exacerbated when tight shoes providing little room for the forefoot are worn. Activities which over-pronate the foot (such as walking barefoot in sand) may increase the pain associated with Morton?s Neuroma, as will any high-impact activity, such as jogging.

Symptoms

The most common symptom of Morton’s neuroma is localized pain in the interspace between the third and fourth toes. It can be sharp or dull, and is worsened by wearing shoes and by walking. Pain usually is less severe when the foot is not bearing weight.

Diagnosis

Patients with classic Morton?s neuroma symptoms will have pain with pressure at the base of the involved toes (either between the 2nd and 3rd toes, or between the 3rd and 4th toes). In addition, squeezing the front of the foot together can exacerbate symptoms. As well, they may have numbness on the sides of one toe and the adjacent toe as this corresponds with the distribution of the involved nerve.

Non Surgical Treatment

The first step in treating Morton’s Neuroma is to select proper footwear. Footwear with a high and wide toe box (toe area) is ideal for treating and relieving the pain. The next step in treatment is to use an orthotic designed with a metatarsal pad. This pad is located behind the ball-of-the-foot to unload pressure, and relieve the pain caused by the neuroma.

If problem persists, consult your foot doctor.intermetatarsal neuroma

Surgical Treatment

If your pain continues despite several months of conservative treatment, your doctor may recommend surgery to remove the neuroma or to widen the space through which the affected nerve travels. These types of surgery often are done under local anesthesia. If your doctor removes a portion of the affected nerve along with the neuroma, you may develop permanent numbness between the toes.

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Can Neuropathy Cause Hammertoes

HammertoeOverview

Hammer toes can result in pain and difficulty in moving the toe. Corns, calluses and blisters can occur from the rubbing of the contracted toe against the inside of the footwear. Both Hammer toe and mallet toe can cause pain during walking, running and other activities. If left untreated, the tendons of the toe may contract and tighten, causing the toe to become permanently stiff and contracted. A podiatric physician or surgeon may have to cut or realign tendons and/or remove pieces of bone to straighten the toe. This may require that the bones be fixed temporarily with pins while the toe heals.

Causes

Those fashionable shoes. Women tend to cram their feet into too-narrow, ill-fitting shoes with little to no arch support. That?s why we see more hammertoes in women than men. Pointy, high-heeled shoes put severe pressure on the toes and their joints, and they typically have little to no arch support. Neuromuscular diseases can contribute to the development of hammertoe, too. People with diabetes can be at increased risk for complications from a hammertoe. In diabetics, if a toe has a corn or other ulceration, it indicates there is too much pressure on the toes. In those with poor blood flow or neuropathy, these lesions can get infected and lead to the loss of a toe or foot unless shoes are modified.

Hammer ToeSymptoms

Common symptoms of hammertoes include pain or irritation of the affected toe when wearing shoes. corns and calluses (a buildup of skin) on the toe, between two toes, or on the ball of the foot. Corns are caused by constant friction against the shoe. They may be soft or hard, depending upon their location. Inflammation, redness, or a burning sensation. Contracture of the toe. In more severe cases of hammertoe, open sores may form.

Diagnosis

Your doctor is very likely to be able to diagnose your hammertoe simply by examining your foot. Even before that, he or she will probably ask about your family and personal medical history and evaluate your gait as you walk and the types of shoes you wear. You’ll be asked about your symptoms, when they started and when they occur. You may also be asked to flex your toe so that your doctor can get an idea of your range of motion. He or she may order x-rays in order to better define your deformity.

Non Surgical Treatment

In the early stages, the hammertoe deformities from mallet toe, claw toe and hammertoe can be corrected. But if treatment is delayed too long, permanent stiffness can ensue which can only be corrected by surgery. The most effective treatment options are good fitting footwear. Shoes with a wide toebox will be more comfortable and will reduce the tension on the muscles and friction on the toes. Avoid high heels as they push your feet forwards to the front of the shoes. This increases the pressure on the toes, forcing them to bend more than usual. Shoes should ideally be half an inch longer than your longest toe. Exercises to strengthen and stretch the muscles can be really helpful. Simple things like trying to pick marbles up with your feet or scrunching up a towel underneath your foot can work well.

Surgical Treatment

If your toe is not bendable, your doctor may recommend surgery. The type of surgery that will be performed will depend on the severity of the condition. You should expect blood and urine studies before the procedure, as well as x-rays of your feet. Your doctor will inject either a local or regional anesthetic. If your toe has some flexibility, the doctor may be able to straighten it by simply making an incision in the toe to release or lengthen the tendon. If the toe is not flexible, your doctor will probably make the same incision to release the tendon, but he or she may also remove some pieces of the bone so that the bone can be straightened. A k-wire is placed in the toe to help hold it straight while it is healing. This is taken out after about four weeks.

HammertoePrevention

Plainly put, most toe deformities are caused by footwear. If you wish to avoid bunions or hammertoes, or works towards reversing them, please choose your footwear that has a low heel, and is wide enough in the toebox to spread you toes. Your podiatrist or therapist can help with the manipulation exercises. Bunion splints are available.