In Part 1 we discussed pain in the ball of the foot, and boy was it thrilling! This week it gets even better, because now we are moving from metatarsalgia, a common condition afflicting my NYC podiatry patients, and onto Morton’s neuroma! It’s even better than an episode of that King of the Nerd show on cable starring the guys fromRevenge of the Nerds.
So what is a neuroma?
A neuroma is a swelling of a nerve running between the metatarsal bones, or long bones, in the ball of the foot. The condition most commonly presents itself in the space between the third and fourth toes, and can feel achy, burning, numb, like stepping on a pebble, or as many other painful sensations – in other words, like other nerve conditions, the pain can be variable and hard to describe. This pain is also different from metatarsalgia, which is felt directly on the metatarsal bone. Many factors can be involved in the development of a Morton’s neuroma (first described by Dr. Robert Morton – go figure) including increased activity, weight gain, tight shoes or injury. In most cases, patients cannot identify any one factor that may have caused the condition to develop.
And how is it treated?
My first line of treatment – brace yourselves – is a cortisone injection into the space. I have found this to be the most effective initial treatment because it reduces pain and inflammation almost immediately. This is followed by the use of comfortable wide shoes that don’t compress the nerve between the metatarsal heads. Metatarsal pads are also effective in reducing the pressure on the nerve, and of course custom orthotics are very beneficial. If these treatments fail, the condition can be treated surgically, which traditionally involved removing the nerve. However, thanks to a new technique, we can now release a ligament around the nerve via a straightforward, endoscopic, outpatient procedure with minimal trauma and downtime, and with very promising results.
So if your foot-ball is on fire as you walk the streets of NYC, and you think you have a Morton’s neuroma, you probably do. Stop suffering already, and call for help.
See you in the office.
Dr. Ernest L. Isaacson