I feel like walking on pebble or stone: pain under ball of foot: Mortons Neuroma

Do you ever get the impression that your sock is folded over or that there's a rock in your shoe, only to discover that it's not the case?

Do you have an intense, burning ache in the ball of your foot that travels to your toes?

It's possible that you have Morton's neuroma or intermetatarsal bursitis. It's a prevalent foot problem that affects one out of every three people.

What Exactly Is a Morton's Neuroma?

It is not a true neuroma but is fibrosis of the nerve which is caused due to pressure or repetitive irritation leading to thickness of the nerve, located in the third or second web space or between 2nd and 3rd or 3rd or 4th toes.

According to Journal of Clinical Orthopedics Trauma, compression and irritation of the nerve cause the thickening of the nerve and causes nerve to grow, resulting in Morton's neuroma symptoms and eventually permanent nerve damage. Neuromas are benign (non-cancerous) tumors. There is no tumors development in Morton's neuroma. Instead, the nerve's surrounding tissue becomes irritated and enlarges (Bhatia and Thompson 2020).

Current data shows that minimally invasive treatments such as Ultrasound Guided Corticosteroid Injections can significantly reduce the need for surgery in patients with persistent Morton's neuroma unresponsive to conservative measures (Klontzas et al 2021).

What does a Morton’s neuroma look like?

You may not be able to see or feel anything on the underside of your toes when you look at them. Because Morton's neuroma is not a tumor.

What does it feel like?

The following are the most prevalent Morton's neuroma symptoms:

·        The sensation of a lump in your shoe or as though you have a marble in your shoe.

·        In the ball of your foot, there is a sharp, scorching sensation.

·        In the toes, there may be stinging, burning, or numbness.

·        The ache usually subsides after night.

·        Walking or wearing tight-fitting, high-heeled footwear aggravates pain between the toes, which is eased by removing the footwear and relaxing.

·        Shooting sensations may be felt around the ball of your foot or the base of your toes.

Why did I get a Morton’s neuroma?

Morton's disease is caused by an unknown factors. There are number of factors as follows:

·        High heels can put a lot of pressure on your toes and balls of your feet.

. Shoes that are too tight or don't fit properly also cause this. Snow skiing and rock climbing, both of which need tight shoes, can cause toe discomfort.

·        High-impact sports, such as jogging or tennis, can put a strain on the feet.

·        Participating in high-impact activities, such as running, can cause repetitive foot injuries.

·        Your very own feet: Morton's disease is more likely to develop if you have flat feet, high arches, deformed toes ("hammer toes"), or other abnormalities.

How is Morton’s neuroma diagnosed?

Morton's neuroma does not have a specific test. We make a diagnosis based on your medical history, physical examination and ultrasound scan. According to Journal of Clinical Orthopedics Trauma Ultrasound and Magnetic Resonance imaging (MRI) are comparable modalities for diagnosing Morton’s neuroma (Bhatia and Thompson 2020). Ultrasound enables both diagnosis and treatment during the same session. Ultrasound guided injections provide immediate alleviation of pain, which also serves as an indirect confirmation of the diagnosis (Klontzas et al 2021).

Other reasons of your symptoms, such as a stress fracture, foot abnormalities, or arthritis, may be ruled out through X-rays. During a physical examination, your clinician will:

•  Examine your feet to discover if you have a lump between your toes.

• To locate the source of foot pain, apply pressure to the gaps between the toe bones.

Is Morton's neuroma a condition that can be treated?

Morton's neuroma is not self-resolving. However, depending on the type of shoes you wear and the amount of time you spend on your feet, your symptoms may come and go.

What if Morton's neuroma isn't treated? It's a tough call. It's possible that your symptoms will improve or even disappear. They could also deteriorate, leading you to hobble or fall. Foot pain that lasts more than a few days, according to our advice, should not be ignored.

What is the best Morton's neuroma treatment?

Your clinician will first ascertain how long you've had the neuroma and assess its stage of development before coming up with a treatment plan. Treatment methods differ depending on the severity of the issue.

Treatment options for neuromas include:

Padding: Padding techniques support the metatarsal arch, reducing pressure on the nerve and compression while walking.
Icing: Swelling can be reduced by applying an icepack to the afflicted area.
Orthotic devices: Your clinician can create custom orthotic devices to give the support needed to relieve pressure and compression on the nerve.
Changes in activity: Until the disease improves, avoid activities that place repetitive pressure on the neuroma.
Shoe Modifications: Avoid shoes with a tiny toe box or high heels and opt for shoes with a large toe box.
Medications: To relieve pain and inflammation, nonsteroidal anti-inflammatory medications (NSAIDs) may be prescribed by clinicians.
Ultrasound Guided Injection: Cortisone injections and local anaesthetics under the ultrasound guidance is used to treat the condition. The use of injection is very common in the management of Morton’s neuroma. Saygi et al. (2005) reported that orthotics on their own may not be very helpful and reported 82% of patients who received 2–3 corticosteroid injections had complete satisfaction in long term.

Ultrasound Guided Injection for Morton’s Neuroma - Intermetatarsal bursitis

When is surgery required?

Surgery for Morton's neuroma may be required in extreme situations where symptoms do not improve with conservative therapies. To relieve pressure on the nerve, the surgeon will either remove it or cut away adjacent structures.

How long does it take for Morton's neuroma to heal? If you have surgery, you may be required to use crutches for around three weeks. It can take up to 6 weeks to fully recover.

Radiofrequency ablation is another treatment option which involves inserting a probe into the neuroma. The probe is then heated to between 85 and 90 °C. Radiofrequency ablation is not recommended as routine treatment by National Institute of Clinical Excellence (NICE) United Kingdom.

Wearing correctly fitted, comfortable shoes as much as possible is the most critical thing you can do to avoid Morton's neuroma. If you are experiencing symptoms and believe your foot discomfort is caused by Morton's neuroma, you should seek medical attention. Please contact our Reception to schedule an appointment. We'll gladly examine you and, if necessary, treat your Morton's neuroma.

To book for an appointment you can call our normal reception line, 0121 285 5656 or email direct to hello@thepodiatryclinics.co.uk requesting an appointment. Please include your name, date of birth, your address and GP contact details.

You will be sent a form to complete and forward back to us or bring along on the day.

References:

J Clin Orthop Trauma. 2020 May-Jun; 11(3): 406–409. Published online 2020 Apr 10. Morton’s neuroma – Current concepts review. Maneesh Bhatia and Lauren Thomson

Saygi B., Yildirim Y., Saygi E.K., Kara H., Esemenli T. Morton neuroma: comparative results of two conservative methods. Foot Ankle Int. 2005

Overview | Radiofrequency Ablation for Symptomatic Interdigital (Morton’s) Neuroma | Guidance | NICE.

J Ultrason. 2021 Jun 7;21(85): Ultrasound-guided treatment of Morton's neuroma. Michail E Klontzas , Emmanouil Koltsakis, George A Kakkos, Apostolos H Karantanas