Morton's neuroma

Thickening of the nerve fiber at the base of the toe with pain and difficulty walking is Morton's neuroma. The pathology is not at all malignant. The name was fixed historically - due to palpation of the formation on the nerve fiber. Young women are susceptible to the disorder due to the peculiarity of wearing high-heeled shoes. Most often the defect is one-sided. It is not life-threatening, but requires timely medical intervention to prevent severe pain.

More about the disease

Morton's neuroma is a common pathology, it is characterized by fibrous thickening of the tissues of the foot that are located around the plantar nerve.
It runs between the third and fourth metatarsals. Depending on the frequency of damage, they distinguish between unilateral and bilateral neuromas. The latter are much less common.

This disease is also known as interdigital neuroma, Morton's syndrome, intermetatarsal neuroma, Morton's finger syndrome, and perineural fibrosis.

Competencies

Reasons for development
How the disease develops
Symptoms
Diagnostics
Consequences of the disease
Treatment

Morton's neuroma is a pathology that is characterized by the appearance of a fibrous formation on the foot in the area of the plantar nerve. The disease has other names: Morton's finger syndrome, interdigital neuroma, perineural syndrome. They are all synonyms. Neuroma occurs in both women and men. However, women still get sick more often, especially in mature and old age - after 45–50 years.

Reasons for the development of the disease

The risk of developing Morton's toe syndrome is caused by several factors that negatively affect the tissues of the foot.

These include:

Traumatic injuries of the foot, accompanied by compression of nerve formations in the interosseous space;
Transverse flatfoot, which deforms the foot and disrupts its normal innervation;
Hematomas (soft tissue bruises) pressing on the nerve;
Chronic infections affecting the tissues of the foot;
Obliterating diseases of the legs that interfere with blood supply;
Prolonged physical activity with the patient constantly in a standing position (for example, at work);
Obesity, which gradually leads to foot deformation and compression of the plantar nerve.

Also, the shoes worn by the patient play a big role in the development of Morton's neuroma. You should not buy constricting, uncomfortable shoes and boots - this leads to disruption of the blood supply and innervation of the tissues of the foot.

As you can see, perineural fibrosis can be caused by many unrelated causes. Only an experienced surgeon can determine what exactly causes the disease and how to cure it.

How does Morton's neuroma develop?

Most often, Morton's neuroma develops in the space between the third and fourth toes - the third intermetatarsal space. The disease is usually unilateral. In rare cases, with rapid onset and early progression of perineural fibrosis, neuroma can form on both sides.

The main pathological factor in the development of the disease is excessive pressure exerted on the bones of the foot. The bones become deformed and change position, causing the plantar nerve to be compressed. An inflammatory process develops around the damaged tissues, which ends with the active growth of connective tissue in the area and its fusion with the bones and muscles of the foot. The fibers that make up the plantar nerve degenerate and form so-called growth flasks, as well as Perriconcito spirals. The normal innervation of the foot is disrupted.

Symptoms

Morton's neuroma is characterized by a specific set of symptoms:

Pain.
Aching, at first it occurs only after physical exertion or long walking, then the discomfort intensifies significantly, and the periods of absence of pain are reduced. The presence of night pain is not typical for Morton's disease. Most often, discomfort is localized between the 3rd and 4th toes, but sometimes it can spread to the entire foot.
Itching and burning in the affected area.
Symptoms are associated with disruption of the nerve innervation of the foot.
Unpleasant sensations when wearing shoes.
The patient feels discomfort, as if some object was shoved into his shoe that is not actually there.

Morton's disease is characterized by a slow onset. Over time, the signs of the disease intensify, and the disease increasingly interferes with the patient’s ability to walk normally. In severe cases, symptoms of the pathology can also occur at rest, when the patient does not move for a long time.

A characteristic sign of perineural fibrosis is the absence of foot deformities that are visible to the naked eye. The slightest displacement of the bones is enough to compress the nerve. In this case, outwardly the leg will look completely normal, changes are noticeable only at the microscopic level.

Diagnostics

A surgeon diagnoses Morton's neuroma. The patient’s complaints are of great importance - the patient needs to be told in as much detail and clearly about the symptoms as possible. The doctor also pays special attention to the medical history. The patient needs to remember when he felt the first signs of pathology, when they intensified, and how their severity changed over time. It is important to determine under what circumstances pain appears - during strong and prolonged physical activity or during small ones. This will help you understand how severely the plantar nerve is affected.

To clarify the diagnosis, the doctor conducts a local examination of the foot with palpation of its surface. When compressed, pain is clearly defined, localized in the area of the third intermetatarsal space. The appearance of numbness of the fingers during palpation in this area also indicates the presence of Morton's neuroma in the patient. There should be no external changes on the foot; bone deformation indicates the presence of concomitant pathologies or an incorrect preliminary diagnosis.

Often, to exclude other diagnoses, the patient is prescribed an X-ray examination, in which all bone formations are clearly visible. If the doctor has doubts about the nature of the disease, he sends the patient for an MRI. This technique makes it possible to visualize the soft tissues of the foot.

To determine the exact location of perineural fibrosis, local anesthetics are injected into the affected area. If the pain suddenly disappears, then the pathological focus is identified correctly. Based on all the data obtained during the examination, the doctor makes an accurate clinical diagnosis and prescribes surgery to remove Morton's neuroma.

Consequences of the disease

With timely consultation with a doctor and proper treatment, the prognosis for the patient is favorable. But if the patient does not pay attention to the alarming symptoms or completely ignores them, Morton's disease will progress over time. Strong physical exertion will become unbearable for the patient, he will not be able to walk for a long time. You can also forget about playing sports. Such consequences can be avoided if you consult a doctor when the first symptoms appear. The doctor will select the right therapy and, if necessary, prescribe surgical treatment.

Treatment of Morton's neuroma

Treatment of Morton's finger syndrome can be either conservative or surgical. Only a large complex of therapeutic procedures will help the patient get rid of an unpleasant disease.

The extent of treatment depends on the severity of symptoms and the stage of the disease - the doctor determines how to treat Morton's neuroma, taking into account various factors.

Conservative treatment

In the early stages of Morton's neuroma, the patient usually does not require surgery. The syndrome can be cured with conservative therapy, the main goal of which is to reduce pressure on the arch of the foot and ease the load on the bone formations.

For mild cases of the disease, it will be enough to follow a number of rules:

Choose comfortable, soft shoes that fit well and don’t squeeze your feet. Preferably with a flat sole;
Buy special orthopedic insoles;
Reduce the load on the foot - walk less, avoid prolonged standing;
Do a foot massage daily.

By following these recommendations, a patient with a mild form of neuroma can quickly get rid of pain and discomfort in the legs.

To treat Morton's finger syndrome, analgesics that block pain are actively used:

Nimesulide;
Diclofenac;
Solpadeine;
Codelac.

Physiotherapeutic treatment is of great importance in conservative therapy. This may be electrophoresis of the affected area, the use of diatoks, laser, or electromagnetic radiation. During the rehabilitation period, after the exacerbation of Morton's disease has stopped, the patient is recommended to perform a special set of physical therapy exercises aimed at restoring normal activity of the limbs.

Unfortunately, conservative treatment for Morton's neuroma is not always effective. In most cases, surgery cannot be avoided.

Surgery

Surgical treatment is necessary when the pathology is in advanced stages and its conservative therapy does not produce results.

Doctors identify several ways to eliminate Morton's finger syndrome:

The simplest method is ectomy (removal) of the neuroma. The surgeon makes an incision in the interdigital space, finds the affected nerve and removes the resulting formation. After this, he places interrupted sutures on the surface of the wound and removes them two weeks after the operation.
The second method involves releasing (cutting) the transverse metatarsal ligament. This leads to the fact that the compression of the nerve disappears and the innervation is restored. At the same time, the integrity of the nerve itself is also preserved, which is very important in the treatment of the disease.
Osteotomy is rarely used. During the operation, the bone is carefully sawed in a strictly defined place. This relieves compression of the plantar nerve. This method is also called an artificial fracture.

After removal of Morton's neuroma, a period of rehabilitation begins. During this time, the patient should limit all stress on the legs, wear only comfortable shoes without heels and avoid hypothermia of the foot.

In severe cases of pathology, radical surgery is required, in which the inflamed area of the foot is simply excised. Such intervention is carried out very rarely, only if there are strict indications.

Many sites advise ways to treat Morton's neuroma using traditional medicine methods at home. Unfortunately, we have to admit that such treatment is ineffective. Various tinctures and ointments can eliminate symptoms and relieve pain, but the disease itself will not disappear and will steadily progress.

Without proper treatment, the prognosis for the patient is disappointing. You should not ignore the symptoms of the disease, otherwise you will have to deal with serious consequences. Morton's disease is a complex pathology with a constantly progressive course. Therefore, if symptoms appear, be sure to schedule a preventive examination with your doctor.

Causes of the disease

Among the causes of this disease are:

wearing high-heeled shoes for a long time;
mechanical injury that causes compression of the nerve passing between the 3rd and 4th fingers;
hereditary predisposition;
various infections of the lower extremities;
excess body weight, which puts a lot of pressure on the foot area;
bruises, injuries, leg diseases (acute and chronic);

flat feet;
wearing uncomfortable tight shoes;
increased physical activity;
neoplasms in the foot area.

At risk are:

salespeople, hairdressers, models, office workers;
tennis players, runners.

Symptoms of the disease

Main clinical signs of the disease:

numbness of the fingers of the affected lower limb;
tingling sensation between fingers;
impaired sensitivity of the third and fourth toes, up to its loss;
sensation of a foreign body under the affected foot;
inability to wear shoes, the appearance of discomfort and attacks of burning pain, lumbago;
swelling in the area of the affected foot;
pain during exercise.

All of the above clinical symptoms can also occur in other traumatological and neurological pathologies. Therefore, it is very important to conduct a correct and reliable diagnosis to choose the right treatment.

At the department of the GMS Hospital center, doctors will give you a professional examination and differential diagnosis of Morton's neuroma with other pathologies using modern research methods. They will also select individual treatment tactics.

EMG, ENMG

Electromyography (or electroneuromyography) is prescribed to assess the bioelectrical activity of muscles, on the basis of which a conclusion is drawn about the functional state of the nerves innervating these muscles. EMG results allow the doctor to determine the nature and severity of damage to muscle tissue and peripheral nerves, which can lead to symptoms similar to those of Morton's neuroma.

Contraindications to ENMG include the presence of a pacemaker, acute cardiovascular pathology, and skin lesions of various etiologies at the site of intended exposure. No special preparation is required for the procedure; within a few hours it is advisable to stop consuming foods that increase excitability (cola, coffee, chocolate).

Of all the listed types of hardware studies, only ultrasound allows one to visualize Morton's neuroma, but the use of other techniques is no less important if there are suspicions of other foot diseases and they need to be differentiated. A consultation with a specialist doctor will give you the opportunity to understand exactly which studies are needed and which are not in your case. For consultation, you can contact any clinic.

Morton's neuroma treatment cost

The prices indicated in the price list may differ from the actual prices. Please check the current cost by calling +7 495 104 8605 (24 hours a day) or at the GMS Hospital clinic at the address: Moscow, st. Kalanchevskaya, 45.

Name	Common price	Price with 30% discount
Excision of Morton's neuroma	RUB 118,800	RUB 83,160

Prices for the most popular services are indicated with a 30% discount, which is valid when paying in cash or by credit card. You can be served under a VHI policy, pay separately for each visit, sign an agreement for an annual medical program, or make a deposit and receive services at a discount. On weekends and holidays, the clinic reserves the right to charge additional payments according to the current price list. Services are provided on the basis of a concluded contract.

Plastic cards MasterCard, VISA, Maestro, MIR are accepted for payment. Contactless payment with Apple Pay, Google Pay and Android Pay cards is also available.

Make an appointment We will be happy to answer any questions Coordinator Oksana

Why is surgical treatment necessary?

Surgical treatment is indicated when the disease causes acute shooting pain. If the disease lasts for a long time and you do not see a doctor in a timely manner, complications may appear, for example, a constant deterioration in the general condition, increased pain, even restriction of movement in the affected limb. The prognosis in this case may be unfavorable.

Therefore, it is very important to seek medical help at the first symptoms, otherwise every day it will be more difficult for you to take a step and engage in physical activity in the gym.

Self-medication is contraindicated, as you can harm yourself and worsen the course of the disease.

Homemade ointments

Homemade ointments, like other folk remedies for treating Morton's neuroma, help alleviate the course and minimize the symptoms of the disease.

The most effective include:

Ointment based on animal fat (pork, badger, goose).

To prepare it, you need to take 100 grams of fat, add one spoon of table salt and mix thoroughly. Apply the resulting mixture daily to the inflamed area, gently rubbing. You can leave the product on overnight, applying a bandage and putting a warm sock on top.

Ointment with bay leaves and pine needles.

You need to chop the bay leaf to make two tablespoons, and pine needles to make one tablespoon. Mix. You need to add fifty grams of butter to the resulting mixture and mix again. The prepared ointment is applied to the affected area daily.

Diagnosis of the disease

At our GMS Hospital center, doctors use modern methods for diagnosing Morton's neuroma. These include:

examination by a doctor, palpation, percussion of the affected limb;
collection of complaints, life history, illness, as well as allergy and hereditary history;
laboratory research methods - general and biochemical blood tests;
instrumental diagnostic methods - radiography, CT, MRI, ultrasound of the affected lower limb;
consultations with other specialists - neurologist, traumatologist, orthopedist, podologist.

After you have undergone all the necessary research and you have received advice from the necessary specialists, the doctor can confirm the diagnosis and choose treatment tactics.

Treatment of the disease

Doctors choose the main method of surgical treatment in the department of the GMS Hospital center - excision of Morton's neuroma. This operation is one of the most modern, safe, and also effective. It refers to minimally invasive methods, which means that during the operation you will not feel pain, the incision will be minimal and you can quickly return to your previous lifestyle.

The essence of surgery is excision of the inflamed area of the foot.

The operation is carried out in several stages:

first, preparatory – treatment of the skin at the site of excision;
the second is performing local anesthesia (the doctor first selects the necessary drug);
third – incision, immobilization, excision of the formation;
fourth, final – suturing and sterile dressing.

After the surgery is completed, you can go home; the rehabilitation period lasts from 2 weeks to 1 month. During this time, you will need to visit the doctor several times to examine the surgical wound and change the bandage. Sutures are usually removed 5-7 days after surgery.

You have questions? We will be happy to answer any questions Coordinator Tatyana

Exercise therapy

Performing special exercises is another home method for treating Morton's syndrome. Exercise therapy will reduce unpleasant symptoms and help restore joint mobility. Exercises can be found on the Internet, but they should be discussed with your doctor.

All exercise therapy exercises in the treatment of Morton’s pathology are aimed at:

Crick,
Their strengthening
Maintaining balance.

Interesting!
Despite the fact that patients with neuroma are advised to rest. Most doctors recommend exercise therapy to strengthen the muscles and ligaments of the foot.

Stretching exercises

Stretching the muscles can reduce pressure on the neuroma. When performing these exercises, you should fix your foot in one position for 10–15 seconds. This will enhance the effect of the treatment.

Exercises to strengthen the plantar part of the foot:

With your right hand, firmly squeeze your heel, and with your left, your toes. Next, pull the toe towards the shin. Repeat 3-5 times,
Repeat the exercise without hands. The number of repetitions is the same.

Exercises to relieve muscle tension:

Stand facing the wall, spread your legs shoulder-width apart. Place your palms on the wall, move your right leg back 30-50cm. Press your heels to the floor, bend your knees, and hold for 10-15 seconds. Repeat 3-5 times,
Freeze a plastic water bottle. Lay it on the floor. Place your foot on top. Roll the bottle back and forth, tensing the muscles of the foot,
Take a waffle towel. Sit on the floor with your legs stretched out. Place your toes in the middle of the towel. Use your hands to pull the towel so that your toe points toward your shin. Repeat 7-10 times.

Exercises to strengthen muscles

To strengthen your foot muscles, you will need to perform the following exercises daily:

While walking on the floor, extend your big toe, drawing a figure eight in the air. Gradually increase the range of movements. Repeat 10-25 times,
Now you should write all the letters of the alphabet one by one with your big toe,
Gently rotate the foot clockwise and then in the opposite direction. Make sure that the amplitude is maximum. Repeat 10-15 times.

Exercises for balance

Good stability will increase the mobility of the joints of the foot, reduce pressure on the neuroma and reduce pain. The following exercises are useful:

Alternately stand on your right and left legs, trying to maintain your balance for as long as possible. To complicate the exercise, you can close your eyes or perform movements with the second leg,
Place your feet shoulder-width apart. Carefully rise onto your toes, holding this position for 5-10 seconds. Repeat 15-20 times.

On a note!
When performing exercises to treat neuroma, you should increase the load gradually so as not to increase compression of the nerve. If the pain increases, exercise therapy should be stopped and consult a doctor.

Disease prevention

Preventive methods are aimed at proper adherence to the postoperative regimen, following all doctor’s recommendations, and wearing orthopedic shoes.

Also, to prevent the development of the disease, it is necessary:

wearing correct, comfortable shoes of your size;
prevention of flat feet;
regular massage and foot baths;
maintaining a healthy lifestyle - proper nutrition, moderate exercise.

If pain or numbness of varying intensity appears in the foot, consult a doctor; only a specialist can help you overcome this disease quickly and effectively.