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Sole Survivor: Beating Morton's Neuroma
That “phantom pebble” and its accompanying pain may not be your imagination, but rather a common condition known as Morton's neuroma.
Most often found in the spaces near the second or third toe, Morton's neuroma results from a swelling of a nerve or adjacent tissue. The swelling can be enough to cause pain, but can also lead to the formation of a cyst, with the resulting effect ranging from minor annoyance, to severe burning or shooting pain.
"Even minor pain may cause you to limp or change your walk, which leads to other problems because your natural walking mechanics are all off," explains John S. Steinberg, DPM, FACFAS, program director for the MedStar Washington Hospital Center's Podiatric Residency.
While nearly everyone can experience Morton's neuroma, it most frequently afflicts runners and other active people, as well as those who often wear high heels or dress shoes.
"Toes that are forced into a tight space for a long time undergo extra pressure that, in turn, causes the swelling and pain," Dr. Steinberg says. "Combine that with high-impact activities, and it's easy to see how the toes will be affected."
Because the symptoms of Morton’s neuroma are so common,a patient’s description is often all a physician needs to make a diagnosis, though an ultrasound or MRI may be performed to verify the extent of the condition and to rule out any other contributing factors.
Treatment options vary, and are usually quite simple. They most commonly include physical therapy and injections of cortisone or alcohol solution to reduce swelling around the nerve. In some cases, the physician may prescribe custom orthotics to correct foot mechanics and separate the toes to prevent them from being compressed.
Only in the most extreme cases of Morton’s neuroma is surgery called for, says Dr. Steinberg.
“The old school approach was to simply remove the nerve, which was found to cause long-term problems,” he says. “Now, foot surgeons or plastic surgeons can perform an external neurolysis, which releases ligaments and tight tissue from around the nerve to create space. But again, such procedures can usually be avoided with proper conservative care measures.”
Morton’s neuroma also may be fully treatable without seeing a physician. Over-the-counter anti-inflammatory medications can reduce the swelling and pain, as will soaking the toes in alternating baths of comfortably hot and ice water. Full-length arch supports with solid shells can help ensure the feet receive the proper support. For athletes, a break from high-impact activities may be all that’s needed.
Of course, the best treatment for Morton’s neuroma is prevention.
“Change to shoes that are better fitting,” Dr. Steinberg advises, “so that toes will have the space and support they need.”