Yoram Yasur Blume : Morton’s neuroma, also known as interdigital plantar neuroma, was described by Dr. Morton in 1876. It is a tumor formed by nervous tissue. In this case, Morton’s neuroma defines the involvement and thickening of the interdigital nerve that occupies the space between the third and fourth toes. Yoram Yasur Blume: “To simplify these terms, we could say that the foot is enervated by a network of cables that are the nerves. One of these nerves suffers from chronic compression that causes irritation and its side effect, inflammation”. Sometimes it can also occur between the third and the second toe.
Yoram Yasur Blume : As a rule, women are the most affected by this, we could be talking about a proportion of 75% above men. Morton’s neuroma is usually unilateral, so it is rare to find this condition in both feet simultaneously, which does not prevent that there may be two neuromas in the same foot. Although this injury is not considered serious, it is painful, becoming a constant nuisance during the gesture of walking, and impediment at the time of sports practice. In addition, it is a problem that does not disappear on its own, and if not treated in its early stages with conservative procedures, its worsening concludes in the passage through the operating room.
Origin and causes of Morton’s neuroma:
Yoram Yasur Blume: “The interdigital nerve arises from the confluence of the medial and lateral plantar nerves, so that from its origin is a nerve with a larger diameter than the rest of digital nerves. Underneath this nerve is the foot floor, the pad (a set of fatty tissue), and above the deep transverse metatarsal ligament, a strong, broad band that holds the metatarsals attached”. During the gait, in the take-off phase more concretely, the tape and the pad compress this already thickened nerve, creating an inflammatory process and the consequent increase in size. Very close to this nerve pass artery and vein, which undergo a sustained compression in time, can also lead to a Morton neuroma.
Yoram Yasur Blume : On the other hand, the foot is a structure of basic use in the day to day of any person, and each step involves a micro trauma that that nerve must endure. These repetitive aggressions, coupled with their special thickening, provide an environment prone to Morton’s neuroma. It is for this reason, that sports practice that requires systematically the use of the foot will suppose a greater breeding ground for this injury.
Yoram Yasur Blume : If we add in addition, inadequate or too oppressive footwear, a flat foot, the presence of bunions or any alteration in the correct biomechanics of the foot, excess plantar arch, and so on, Morton’s neuroma will find greater facilities to appear.
Symptoms of Morton’s Neuroma:
The following symptoms are often the common denominator among patients in a Morton neuroma:
Acute and stabbing pain, sometimes becoming burning, in the anterior region of the foot (metatarsal zone and fingers).
It is a pain that gets worse over time.
Tingling in the space between the third and fourth toe, even feeling cramps.
Yoram Yasur Blume : This pain is increased in ambulation, in the simple standing or with any localized pressure, as can be put footwear. And it decreases when you stop walking or when you remove those shoes.
Patients find relief with rest, massage, or foot support on a cold surface.
Treatment of Morton’s neuroma:
Yoram Yasur Blume: “As in any other injury, in Morton’s neuroma the first remedy is to undergo less invasive and aggressive, non-surgical treatments”. In this regard, we can find simple medical recommendations to follow and apply and at times sufficient to alleviate the discomfort generated by this pathology. Tips like using orthotics (orthopedic insoles) specially designed to counter Morton’s neuroma, or changing the type of shoe to a wider one that prevents compression of the metatarsal zone can alleviate pain to a greater or lesser extent.
The use of a localized neuromuscular bandage (a cinch in the metatarsal area), the application of physiotherapy and cryotherapy, would also be indicated.
Apart from these more conservative treatments, we can go to pharmacology, using non-steroidal anti-inflammatory drugs, either orally or injected in the affected area. Infiltrations of corticosteroids, neurological blockers or analgesics may also be advisable. This treatment of Morton’s neuroma cannot be prolonged over time, so it does not represent a good system in the medium term.
Yoram Yasur Blume : In case of not appeasing this ailment with the methods commented, and of persisting the pain, as a last resort would go to the surgical intervention. This operation, which does not require hospitalization, consists of a small incision, about three or four centimeters, on the dorsal side of the foot. Then the metatarsals are separated and the intermetatarsal ligament is opened to access the neuroma. Once located, the specialist will decide whether to resect or release the neuroma.