Morton’s neuralgia is a neurological condition that typically occurs in the forefoot. The condition is also known as Morton’s neuroma.
What is Morton’s neuralgia?
The so-called causative pain of Morton’s neuroma is localized between the second and third toes but also between the fourth and fifth toes. Morton’s neuralgia usually occurs in only one foot, but casuistry has been described in which both feet are affected. Morton’s neuralgia is characterized by so-called neuralgic pain. The affected patients describe these pain attacks as electrifying, burning, shooting and stabbing. In addition, the vast majority of patients describe a radiating pain down to the tips of the toes of the affected foot. Morton’s neuralgia is caused by a neuroma, which is a nerve growth, a fibrous thickening of the nerves starting from the ball of the foot between the metatarsal heads and branching into the toes. At these branch points, just between the second and third or the fourth and fifth toes, the benign nerve tumor, the neuroma, forms.
Causes
The cause of the pronounced thickening of the nerve cord is an endogenous protective mechanism to encase the nerve so that it can no longer become inflamed. The so-called plantar nerves are located in the sole of the foot. The plantar nerves branch finely to the individual toes, where they branch and divide further and finally end as fine nerve fibers on the inside of the toes. The exact causes leading to Morton’s neuralgia are not clearly known. However, there are a number of factors that are suspected to promote the disease. In addition to the genetic predisposition of a too weak connective tissue, strongly elevated heels, a splay foot, narrow, firm shoes or strong stresses on the feet due to constant long walking or standing are considered risk factors. Biomechanical dysfunction due to flat feet can also apparently cause Morton’s neuralgia. Flat feet, in turn, are not infrequently the result of years of obesity.
Symptoms, complaints and signs
Morton neuralgia is initially manifested by nonspecific numbness or foreign sensations in various parts of the body. Typical sensations of discomfort include “formication” in the toes, as well as foreign body sensations in the shoe. These sensations are often accompanied by pain, which can vary depending on the severity and location of the condition. Possible are load-dependent pains that immediately subside after taking off the shoes, but also stabbing pains that linger for a long time. In general, however, the symptoms improve when the patient sits down or takes off shoes and socks. In addition, sufferers are less able to bear weight and have to take frequent breaks. The pain usually occurs on one side; in a few patients, the discomfort is felt in both feet. The pain itself is described by sufferers as stabbing or throbbing. Externally, Morton’s neuralgia can be recognized by any deformities. Thus, a splayfoot may be present, which can be diagnosed by the conspicuous position of the toes. Morton’s neuralgia sets in over the course of several months and slowly subsides with appropriate treatment. If adequate therapy is not given, the symptoms increase and secondary conditions such as metatarsalgia develop.
Diagnosis and course
The diagnosis is initially based on taking the medical history, anamnesis, and asking about risk factors. For example, if firm, narrow shoes are the cause of Morton’s neuralgia, the feet had no possibility to roll forward due to a forefoot part that was much too narrow. As a result, nerve compression occurs, i.e. the nerve is permanently pinched between the bony structures and consequently becomes inflamed. Morton’s neuralgia may also be an occupational disease if the occupation requires constant prolonged walking or standing in improper footwear. If highly elevated heels are the cause, then the body weight constantly shifts to the forefoot and gradually a splay foot can develop as a result. In addition to inspection and palpation of the foot, a conventional X-ray is usually taken to confirm the suspected diagnosis.Morton’s neuralgia occurs predominantly in women, and the onset of the disease is insidious. If not treated in time, the course can also be chronic, especially if both feet are affected.
Complications
Morton’s neuralgia causes the patient to experience discomfort primarily in the feet. The feet may ache and be affected by severe swelling. Likewise, the pain can also occur in the form of pain at rest, leading to sleep disturbances or other sleep complaints at night. As a result, patients not infrequently suffer from psychological discomfort or depression, and the quality of life is significantly reduced by Morton’s neuralgia. The patient’s ability to cope with stress also decreases, and there are restrictions in movement and, furthermore, gait disturbances. Severe pain occurs especially during exertion. Morton’s neuralgia does not heal by itself, so that medical treatment of this disease is necessary in any case. It can also lead to a malpositioning of the foot. If the nerve is pinched, the feet may also be affected by paralysis and other disorders of sensitivity. There is no causal treatment for Morton’s neuralgia. However, the symptoms can be alleviated by medication and by special shoes and insoles. Complications usually do not occur and the life expectancy of the patient is not reduced by Morton’s neuralgia. Not all symptoms can be limited in every case, so patients may have to rely on the therapies for their entire lives.
When should you see a doctor?
Pain in the foot that is not directly related to overuse or physical exertion should be examined and treated by a physician. If there is an increase in pain, medical attention is needed. As a general rule, the use of a painkilling medication should be avoided until a medical professional has been consulted due to possible side effects. A sudden and stabbing pain in the foot is characteristic of Morton’s neuralgia and should be presented to a physician immediately. If the physical load limit drops, a decrease in performance becomes apparent, or if the affected person suffers from a restriction of mobility, a physician is needed. If the pelvis is misaligned, the posture is crooked or there is any other abnormality of the skeletal system, a doctor should be consulted. Without early correction, the affected person risks lifelong damage and discomfort. If the daily requirements can no longer be met as usual, if behavioral abnormalities occur, and if the general well-being decreases, medical help should be sought. In case of optical changes of the foot, peculiarities of the skin appearance as well as disturbances of the blood circulation, a visit to the doctor is advisable. Sensitivity and sensation disorders, numbness or irregularities to temperature effects in the foot should be assessed and treated by a physician.
Treatment and therapy
A strictly causal, i.e., cause-related, treatment of Morton’s neuralgia is therefore not possible because the exact cause of the disease is still unknown. However, individual knowledge of the risk factors can provide relief in most cases. However, since Morton’s neuralgia tends to become chronic, it is essential to avoid these favoring factors permanently after diagnosis. In milder cases, no therapy is usually necessary. Morton’s neuroma should, however, always be treated if pain occurs, activities can only be performed to a limited extent, there are difficulties wearing shoes or the ability to walk is already limited. Basically, Morton’s neuroma can be treated conservatively or surgically, depending on its severity and characteristics. In the vast majority of cases, conservative therapy is first attempted before surgical intervention. This can consist of wearing specially made orthopedic shoes or special insoles to support the entire foot. So-called pads are elevations that are supposed to relieve the forefoot during walking. Regular foot exercises or the injection of local anesthetics directly into the affected areas of the foot are also suitable for pain relief. If all conservative measures fail to bring lasting pain relief, surgery is inevitable.The neuroma, i.e. the benign nerve tumor, can be removed completely. However, even after surgery, it cannot be ruled out that the tumor will grow back in the same place.
Outlook and prognosis
The prognosis for Morton’s neuralgia is highly individualized with conservative treatment. Very often, however, noticeable improvement can be achieved with the simplest relief measures. The feeling of pain may occasionally still occur in patients, but then only with greater stress. If Morton’s neuralgia has progressed to the point where a stabbing pain is permanently felt, conservative therapy usually brings noticeable relief very quickly. Spontaneous healing is sometimes possible with Morton’s neuralgia. Therapy can lead to complete healing over a period of several weeks or months. However, there are patients who do not respond to these therapy methods and accordingly cannot be relieved of their pain. Morton’s neuralgia can also affect a person several times in a lifetime. Accordingly, no one is cured after therapy for this. There seem to be certain factors that increase the risk of recurrence. In any case, what permanently takes away the pain in the foot is the surgical procedure to remove the nerve tissue involved. If the nerves involved are missing, no pain stimulus can be sent to the brain. Thus, permanent freedom from pain occurs.
Prevention
To prevent the recurrence of a Morton’s neuroma after successful surgery, targeted foot exercises, foot baths with anti-inflammatory agents, and elevation of the legs are required, which should also be practiced every now and then during the day. General prevention includes consistent avoidance of risk factors that would favor the occurrence of Morton’s neuralgia. These include comfortable footwear that is not too tight, avoiding or reducing excess weight, reducing heavy exertion by walking or standing for too long, and strengthening connective tissues if there is a genetic predisposition.
Aftercare
In most cases, only limited measures of aftercare are available to the affected person for Morton’s neuralgia. In the first place, the affected person should see a doctor at an early stage to avoid further complications or other complaints in the affected person. The earlier a doctor is consulted, the better the further course of the disease usually is. Therefore, the affected person should contact a doctor at the first signs of the disease. Most patients are dependent on a surgical intervention, which can permanently alleviate the symptoms. After such an operation, the affected person should in any case rest and take care of his body. Efforts or physical and stressful activities should be avoided in order not to put unnecessary strain on the body. Physical therapy or physiotherapy may also be necessary, although the patient can also perform many of the exercises at home to speed up the treatment. Even after a successful intervention, regular check-ups and examinations are important to monitor the current condition of Morton’s neuralgia. Usually, this condition does not reduce the patient’s life expectancy.
What you can do yourself
The disease has a worsened course in patients who suffer increased mental or emotional stress. Good psychological stability should therefore be established and maintained. The inner stress experience can be reduced by using mental techniques. Methods such as yoga, autogenic training or meditation have proven successful. In addition, it is helpful if everyday life is structured in such a way that as little restlessness or agitation as possible develops. Conflicts and disagreements should be avoided or resolved constructively so that emotional relief can be achieved. A fundamentally positive attitude toward life and life circumstances is helpful in coping with the impairments. The use of painkilling medications should be reduced if possible or only used temporarily. The active ingredients of the drugs cause side effects and there is a risk of dependence. Alternative healing methods or the described relaxation techniques can be used to alleviate the symptoms.Overweight should be avoided in patients of Morton’s neuralgia. A healthy and balanced diet can provide the organism with all the necessary vitamins and nutrients. The weight should ideally be in the normal range according to the BMI guidelines. Weight gain or obesity will lead to a deterioration of health, as pain and movement restrictions will increase.
