Dealing With Mortons Neuroma
Overview
A Morton?s Neuroma is actually incorrectly termed, with the name suggesting it is a tumour or growth. Rather than a true neuroma it is actually what is called a perineural fibrosis, which means that over time the sheath surrounding the nerve becomes irritated, inflamed, and forms a thickened scar tissue.
Causes
The pain of Morton's neuroma occurs when the nerve connecting the toe bones (metatarsal bones) becomes irritated or compressed. The exact cause of the irritation is unknown, but it may be the metatarsal bones pressing against the nerve when the gap between the bones is narrow. This causes the nerve and surrounding tissue to thicken. Some experts believe that a number of other foot problems, including flat feet, high foot arches, bunions and hammer toes, may also play a role in Morton's neuroma.
Symptoms
Many patients describe the sensation as a burning pain in the ball of the foot that often radiates to the toes. Initially, the pain may become much more apparent when the person wears tight, narrow or high-heeled shoes, or engages in activities which place pressure on the foot. Eventually, symptoms may be continuous and last for days, and even weeks. MRI (magnetic resonance imaging) scans have revealed Morton's neuroma lesions in patients who had no symptoms at all. Symptoms can become so disrupting that many affected individuals become anxious about walking, or even placing their foot on the ground.
Diagnosis
The doctor will perform an examination of your feet as well. He or she may palpate your feet and flex them in specific ways that will indicate the presence of a neuroma. X-rays are often used to rule out other problems, such as fractures, bone spurs, arthritis or other problems with the bones in the toes or foot. In some cases, an MRI (magnetic resonance imaging) may be helpful to confirm the presence of a neuroma.
Non Surgical Treatment
Sclerosing alcohol injections are an increasingly available treatment alternative if the above management approaches fail. Dilute alcohol (4%) is injected directly into the area of the neuroma, causing toxicity to the fibrous nerve tissue. Frequently, treatment must be performed 2-4 times, with 1-3 weeks between interventions. An 60-80% success rate has been achieved in clinical studies, equal to or exceeding the success rate for surgical neurectomy with fewer risks and less significant recovery. If done with more concentrated alcohol under ultrasound guidance, the success rate is considerably higher and fewer repeat procedures are needed. Radio Frequency Ablation is also used in the treatment of Morton's Neuroma The outcomes appear to be equally or more reliable than alcohol injections especially if the procedure is done under ultrasound guidance.
Surgical Treatment
For severe or persistent pain, you may need surgery to remove the neuroma. Once the nerve is gone, you permanently lose feeling in the affected area. One alternative to surgery is to undergo neurolysis injections. These use chemical agents to block pain signals. Another alternative is to take a prescription pain reliever that alleviates nerve pain.
A Morton?s Neuroma is actually incorrectly termed, with the name suggesting it is a tumour or growth. Rather than a true neuroma it is actually what is called a perineural fibrosis, which means that over time the sheath surrounding the nerve becomes irritated, inflamed, and forms a thickened scar tissue.Causes
The pain of Morton's neuroma occurs when the nerve connecting the toe bones (metatarsal bones) becomes irritated or compressed. The exact cause of the irritation is unknown, but it may be the metatarsal bones pressing against the nerve when the gap between the bones is narrow. This causes the nerve and surrounding tissue to thicken. Some experts believe that a number of other foot problems, including flat feet, high foot arches, bunions and hammer toes, may also play a role in Morton's neuroma.
Symptoms
Many patients describe the sensation as a burning pain in the ball of the foot that often radiates to the toes. Initially, the pain may become much more apparent when the person wears tight, narrow or high-heeled shoes, or engages in activities which place pressure on the foot. Eventually, symptoms may be continuous and last for days, and even weeks. MRI (magnetic resonance imaging) scans have revealed Morton's neuroma lesions in patients who had no symptoms at all. Symptoms can become so disrupting that many affected individuals become anxious about walking, or even placing their foot on the ground.
Diagnosis
The doctor will perform an examination of your feet as well. He or she may palpate your feet and flex them in specific ways that will indicate the presence of a neuroma. X-rays are often used to rule out other problems, such as fractures, bone spurs, arthritis or other problems with the bones in the toes or foot. In some cases, an MRI (magnetic resonance imaging) may be helpful to confirm the presence of a neuroma.
Non Surgical Treatment
Sclerosing alcohol injections are an increasingly available treatment alternative if the above management approaches fail. Dilute alcohol (4%) is injected directly into the area of the neuroma, causing toxicity to the fibrous nerve tissue. Frequently, treatment must be performed 2-4 times, with 1-3 weeks between interventions. An 60-80% success rate has been achieved in clinical studies, equal to or exceeding the success rate for surgical neurectomy with fewer risks and less significant recovery. If done with more concentrated alcohol under ultrasound guidance, the success rate is considerably higher and fewer repeat procedures are needed. Radio Frequency Ablation is also used in the treatment of Morton's Neuroma The outcomes appear to be equally or more reliable than alcohol injections especially if the procedure is done under ultrasound guidance.
Surgical Treatment
For severe or persistent pain, you may need surgery to remove the neuroma. Once the nerve is gone, you permanently lose feeling in the affected area. One alternative to surgery is to undergo neurolysis injections. These use chemical agents to block pain signals. Another alternative is to take a prescription pain reliever that alleviates nerve pain.
