Morton’s Neuroma

The American Orthopaedic Foot and Ankle Society describes Morton’s Neuroma as feeling like you are “walking on a marble,” and you have persistent pain in the ball of your foot. A neuroma is a benign tumor of a nerve. Morton’s neuroma is not actually a tumor, but a thickening of the tissue that surrounds the digital nerve leading to the toes.

Doctors at the Department of Trauma & Orthopaedic Surgery, Scarborough General Hospital  published their review on the diagnosis and management of Morton’s neuroma. In it they call Morton’s neuroma a common condition mainly affecting middle aged women. There are many reasons that can cause Neuroma including chronic repetitive trauma, ischemia (loss of blood supply), entrapment (Nerve compression syndrome), and intermetatarsal bursitis.

They note that the current nonoperative treatment strategies include shoe-wear modifications, custom made orthoses, and injections of local anesthetic agents, sclerosing agents (which can include Prolotherapy and Platelet Rich Plasma), and steroids. Operative management options primarily involve either nerve decompression or neurectomy.1

Many patients come into the office having been misdiagnosed with Morton’s neuroma. This condition affects the toe area, and is caused by nerves getting entangled at the base of the foot or in between the toes. Most often the problems associated with Morton’s neuroma are actually symptoms of metatarsalgia, which is a simple inflammation of the same area. Metatarsalgia has also been very successfully treated with PRP foot injections.

The use of ultrasound guided injections in problems of the Morton’s Neuroma

Doctors at the University Hospitals of Leicester in England explored whether it was better to use ultrasound guided cortisone injections when offering foot pain treatments, than not using the ultrasound guidance. What they were looking for was if the ultrasound improved the cortisone treatments.

What they found was that in dealing with foot anatomy, their study showed that ultrasound guidance did not demonstrably improve the efficacy of corticosteroid injections in patients with Morton’s Neuroma. Secondly a trained clinician who understands the forefoot anatomy may perform an injection without ultrasound guidance with good and safe results.2

1 Jain S, Mannan K. The diagnosis and management of Morton’s neuroma: a literature review. Foot Ankle Spec. 2013 Aug;6(4):307-17. doi: 10.1177/1938640013493464. Epub 2013 Jun 27. Review.

2 Mahadevan D, Attwal M, Bhatt R, Bhatia M. Corticosteroid injection for Morton’s neuroma with or without ultrasound guidance: a randomised controlled trial. Bone Joint J. 2016 Apr;98-B(4):498-503. doi: 10.1302/0301-620X.98B4.36880.

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