What is Morton's Neuroma?
Morton's Neuroma is a term used to describe symptoms and signs such as pain, numbness, and burning sensation in the affected toes, caused by the pressure of the ligament connecting two metatarsal bones on the nerves that provide sensory perception between the toes at the level where the metatarsal bones and toes articulate. It is most commonly seen as a result of compression of the nerve between the 3rd and 4th toes, but it can occur in every toe, including the big toe.
What are the Symptoms ofMorton's Neuroma?
Pain: A burning pain at the junction of the metatarsal bones and toes is characteristic of patients with Morton's Neuroma. The pain often spreads to the toes. Patients with Morton's Neuroma frequently describe feeling as if they are walking barefoot on stones during the examination. The pain decreases during rest and increases with activity. It intensifies after wearing tight, high-heeled shoes, long walks, or sports activities such as running. Patients find relief by taking off their shoes. There is no nighttime pain in Morton's Neuroma.
Numbness: There is numbness in the affected toes. Patients may not be able to fully express the numbness. They describe an uncomfortable sensation in the foot and the affected toes.
Who is Most Likely to Get Morton's Neuroma?
Female Gender: 80% of patients with Morton's Neuroma are women. The main reason is wearing high-heeled and pointy-toed shoes. These types of shoes cause the entire body weight to be concentrated on a single point, resulting in nerve compression and Morton's Neuroma.
Flat Feet: People with flat feet have a higher likelihood of developing Morton's Neuroma due to abnormalities in their gait and weight distribution.
Hallux Valgus:Hallux Valgus can compress the other toes, increasing the likelihood of Morton's Neuroma development.
How is Morton's Neuroma Diagnosed?
Morton's Neuroma can often be easily identified after a detailed history and physical examination. The neuroma can be felt as a mass when the space between the toes is compressed, causing a sharp, burning pain in the toes.
Magnetic resonance imaging (MRI) can detect Morton's Neuroma between the toes. Sometimes there may be multiple neuromas in one foot.
How is Morton's Neuroma Treated?
After diagnosing Morton's Neuroma, treatment should begin with non-surgical methods.
Non-Surgical Methods
Shoe Change: The first step in treatment is to stop wearing tight, high-heeled shoes with hard, thin soles. If Morton's Neuroma is detected early and the patient quickly follows the recommendation to wear appropriate shoes, the nerve damage caused by Morton's Neuroma may be reversible and not recur.
Orthotics: Custom-made orthotics aim to reduce the pressure on the compressed nerve, providing relief. Even though orthotics can be customized, they may be difficult to use for some patients, and it may be necessary to switch to larger shoes.
Ultrasound-Guided Cortisol Injection: The goal of ultrasound-guided cortisol injection for Morton's Neuroma is to inject cortisol around the compressed nerve, providing relief.
Which Patients Should Undergo Morton's Neuroma Surgery?
Surgery should be planned for patients who do not experience significant improvement with non-surgical methods. Although patient satisfaction is high after surgery, the chance of recovery with non-surgical methods for Morton's Neuroma is 80%.
How is Morton's Neuroma Surgery Performed?
In the surgical treatment of Morton's Neuroma, the goal is to release the compressed nerve in the toe and free the surrounding tissues. Additionally, if there is a significant thickening or mass formation in the nerve tissue, this mass is also removed. The surgery is performed with a 2 cm incision on the top of the foot.
After the surgery, a significant improvement in clinical symptoms is observed, and all patients are very satisfied with the results. Therefore, regardless of age and stage of the disease, surgery should not be avoided in patients with Morton's Neuroma who cannot achieve improvement with non-surgical methods.
What is the Process Like After Morton's Neuroma Surgery?
Your wound will heal 10-14 days after the surgery. During this period, you can take a shower with waterproof dressing materials. For the first week after surgery, I recommend not putting too much weight on your foot while walking and distributing most of the weight to your heel.
Athletic patients can start low-intensity exercises in about the 2nd or 3rd week, gradually increasing their training. Full return to sports is around 6 weeks.
