Morton's Neuroma (Interdigital Neuroma, Intermetatarsal Neuroma)

Sex: femaleWearing narrow and/or high-heeled shoesObesityInjuries to the footActivities that cause repetitive trauma to the foot (such as sports-related activities) Symptoms Symptoms of Morton's neuroma include the following sensations, usually between the third and fourth or (less often) second and third toes: Burning, pain, tingling, and numbness often shooting into the toesDiscomfort that is worse while walkingFeeling of a lump between the toes Symptoms are usually temporarily relieved when a person: Takes off their shoesFlexes their toesRubs their feet Diagnosis The doctor will ask about your symptoms and medical history, and perform a physical exam. Initial diagnosis of Morton's neuroma is based on your description of the type and location of pain and discomfort in the foot. The diagnosis will be confirmed by: Physical exam of the foot, including: Checking for mechanical abnormalities in the footSqueezing the side of the foot, doing so will usually cause pain when Morton's neuroma is present Examination of your shoes to: Check for excess wear in parts of the shoeCheck to see whether the shoes are too tight If the diagnosis is still in doubt, an x-ray may be done to rule out another cause of the pain (eg, fracture) An ultrasound may be used to visualize the neuromaInjections of local anesthetic can be used for diagnosis TreatmentTreatments may include:

Rehabilitation Measures to Reduce Nerve IrritationSwitching to low-heeled, wide-toed shoes with good arch supportWearing padding in the shoes and/or between the toesWearing shoe inserts to correct a mechanical abnormality of the footUltrasound, electrical stimulation, whirlpool and massage Injection of MedicationInjecting the foot with corticosteroids mixed with a local anesthetic in order to reduce pain. Relief may be only temporary, however, if the mechanical irritation is not also corrected. Injections with other types of medications such as alcohol, phenol or even vitamin B12 are sometimes used. SurgerySurgery to remove the neuroma may be recommended if more conservative treatment does not solve the problem. While surgery usually relieves or completely removes the symptoms, it often leaves a permanent numb feeling at the site of the neuroma. Prevention Steps to help prevent Morton's neuroma include: Avoid wearing tight and/or high-heeled shoes.Maintain or achieve ideal body weight.If you play sports, wear roomy, properly fitting athletic footwear. RESOURCES: American Academy of Physical Medicine and Rehabilitationwww.aapmr.org American College of Foot and Ankle Surgeonshttp://www.acfas.org American Podiatric Medical Association

http://www.apma.org National Institute of Arthritis and Musculoskeletal and Skin Diseaseshttp://www.nih.gov/niams CANADIAN RESOURCES: Orthogatehttp://www.orthogate.org/patient-education Ontario Podiatric Medical Associationhttp://www.opma.ca/ References: American College of Foot and Ankle Surgeons website. Available at: http://www.acfas.org/ . The Merck Manual of Medical Information . Simon and Schuster; 2000. Scardina RJ, Lee SM. Frontera: Essentials of Physical Medicine and Rehabilitation . Philadelphia, PA; Hanley and Belfus; 2002. Thomson CE. Gibson JN. Martin D. Interventions for the treatment of Morton's neuroma. Cochrane Database of Systematic Reviews. 2004;(3):CD003118. Last reviewed November 2007 by John C. Keel, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.