Morton’s Neuroma can cause burning, tingling, cramping and pain between the third and forth toes. As the name implies, Neuroma refers to an enlargement of the nerve. It is considered a benign thickening of the nerve, as it passes through the bones of the feet. You can get Neuroma in any part of the foot, but it is mostly prevalent between the third and the fourth toes.
The foot and ankle has 26 bones, 33 joints, plus muscles, tendons, ligaments, arteries, veins, nerves and soft tissues. That is an incredible amount of moving, working parts to be crammed into such a small confined space as the foot. Because of the confined space, sometimes nerves can become trapped. That is the case in Morton’s Neuroma.
The nerves in the foot have narrow channels in which to lie. In the case of the nerves between the third and forth toes, two nerves (the lateral plantar and the medial plantar nerves) join and reside in the narrow channel between the toes. As the nerves join together, they become thicker than the other single nerves. It is this thickness that can lead to an impingement between the transverse metatarsal ligament and the ball of the foot. That is the technical explanation.
The trapped nerve then causes tingling or pain in the third and forth toes. This will not get better with time, but rather the symptoms will increase without treatment to relieve the compression of the trapped nerve. While surgery is an option to release the trapped nerve, there is another option that is very effective.
According to Pedram Aslmand, DPM, a foot and ankle specialist in Long Beach, California, “Alcohol injections are about 84% effective in relieving the pain of Neuroma. The beauty of this treatment is there are no incisions, no general anesthesia, and no down time.” A series of injections will be scheduled, and the total number needed depends upon the individual’s pain relief. The majority of patient’s have total relief after 4 injections, but some patients require more.
After the diagnosis of Morton’s Neuroma has been established, the nerve will be isolated by ultrasound guidance. The area will be thoroughly cleansed, and a local anesthetic with a dilute alcohol solution will be injected into the nerve. This will shrink the Neuroma over time.
Patients are monitored for about 15 minutes after the procedure and then are allowed to gently be mobile on that foot. Full activities can be resumed the next day. There are no special dressings to take care of because there is no incision.
What causes Morton’s Neuroma? Aslmand says “No one is really for sure but there are some theories. The hyper-mobility between the bones causes rubbing against the nerve which causes the enlargement of the nerve. The condition is more prevalent in women than in men. It is assumed that the condition is exacerbated with shoes with a small toe box. High heels may also be a problem, as it shifts the weight to the ball of the foot. This will compound the compression of the nerve against the transverse metatarsal ligament.
While these are only suspected culprits, it is always good advice to wear shoes with as wide a toe box as possible. According to Aslmand conservative treatment of alcohol injection, padding, wider shoes and sometimes orthotics can relieve most of the symptoms. If conservative treatment fails over a nine month period, minimal incision excision is very effective.”