Morton´s neuroma / Morton´s metatarsalgia
- Category: Peripheral Nerves
Mortons´s neuroma, also called Morton´s metatarsalgia, is caused by an irritation or compression of toe nerves. Women are more frequently affected than men.
Symptoms Morton´s neuroma (Morton´s metatarsalgia)
Typical symptom of Morton´s neuroma is pain in the forefoot as well as in the third and fourth toe. Especially painful is wearing tight shoes. But there are no complaints when wearing wide shoes or walking barefooted. In the course of Morton´s neuroma, numbness of affected toes can occur. The symptoms of Morton´s neuroma in short:
- pain in forefoot and toes no. 3 and 4
- numbness of affected toes
Causes Morton´s neuroma (Morton´s metatarsalgia)
Morton´s neuroma is caused by an irritation or compression of toe nerves between the metatarsal heads of the second or third foot ray or at height of metatarsophalangeal joints. Permanent pressure brings about a node-like thickening (pseudo-neuroma) at the distribution of toe nerves. An additional compression can emerge through an inflammatorily changed and enlarged bursa, also located between metatarsal heads building a painful connection with the nerve node (ganglion). The disease is predominantly found between third and fourth, more rarely between second and third toe. Women are more likely to suffer from Morton´s neuroma than men.
Diagnostics Morton´s neuroma (Morton´s metatarsalgia)
Morton´s neuroma can be detected by emploing an MRI scanner. With the help of MRI, Morton´s neuroma can be visualized and differentiated from other diseases.
Given a correct diagnosis, Morton´s neuroma can be treated surgically with good results including improvement and being free of complaints.
Therapy Morton´s neuroma (Morton´s metatarsalgia) – neuroma surgery
Morton´s neuroma can be treated with microsurgery, so-called neuroma surgery. Drugs supporting the clotting of blood are to be stopped or substituted before neuroma surgery, if necessary after consulting the family doctor. Patients must have an empty stomach (this comprises eating, drinking and smoking). After the operation, it is not possible to drive the car by oneself but to let another person drive you.
During the out-patient neuroma surgery, regional anesthesia is applied plus optional sedation ('twighlight sleep'). A 3-4 cm (1-1.5 inches) long skin incision is performed at the bridge of the foot in height of the space between the third and fourth or the second and third toe. Given typical Morton´s neuroma, a thickened toe nerve is removed along with the enlarged bursa. Alternatively, a cut through a small ligament (ligamentum intermetatarsale) has to be considered, especially if no typical nerve change is diagnosed. At the end of neuroma surgery, a small drainage is placed into the wound, if necessary.
Aftercare neuroma surgery
To avoid a swelling after the surgical treatment of Morton´s neuroma and to support quick recovery, the feet has to be put up consequently within first postoperative days and must not be strained. Despite these requirements, movement of the ankle for the activation of calf muscles is necessary in order to prevent thrombosis. Bandages are changed and the drainage removed on first day after neuroma surgery by Beta Klinik´s doctors or a family doctor. After 7-10 days, stitches are removed. A day later, washing the foot is possible again. Slowly, the foot can be increasingly strained from now on, although it might be painful within first weeks or longer.
Complications (general/special) neuroma surgery
Small hematoma and swelling disappear spontaneously after the surgical removal of Morton´s neuroma. Additionally to loosening bandages, ice packs have to be applied several times a day in case of sever swellings. But the wound has to be kept dry and must not get wet.
The inflammation or infection rate of patients after neuroma surgery is very low. Given any signs of infections like pounding pain in surgical area, reddening or festering of the wound, a doctor must be consulted immediately. The best is the prompt consultation at Beta Klinik.
A feeling of numbness of exists before surgery due to Morton´s neuroma. Apart from that, numbness can also emerge after neuroma surgery but without having disturbing impacts.
For 20% of patients, the surgical treatment of Morton´s neuroma does not result in a satisfying relief or improvement.
If unexpected symptoms occur after neuroma surgery, for example, severe pain, movement limitations of joints or a severe swelling, please consult Beta Klinik.