10/10/2013 10:56:00 AM High-heeled shoes are often the cause of Morton's Neuroma
DEAR DOCTOR K: I have pain in the ball of my foot. My doctor thinks it is caused by a Morton's neuroma. How did I get this, and what can I do about it?
DEAR READER: Morton's neuroma is a swelling of the nerve between the bones at the base of the toes in the ball of the foot. The pain it causes usually is in one spot. It can feel like you have a pebble in your shoe. Once the nerve starts to swell, the nearby bones and ligaments put pressure on the nerve, worsening the irritation and inflammation. (I've put an illustration of a Morton's neuroma on my website, AskDoctorK.com.)
A neuroma usually occurs between the bones of the third and fourth toes. It causes aching pain, a burning sensation, and numbness and tingling in the toes.
Morton's neuroma is much more common in women than in men. In most cases, high-heeled, narrow-toed shoes are to blame. High heels shift the foot bones into an abnormal position and put pressure on the ball of the foot. This causes the foot bones to put pressure on the nerve, and that increases the risk that a neuroma will form. Once it forms, the same pressure from bones makes it hurt.
Less often, physical activities that stress the feet (such as running or racquet sports) can cause a Morton's neuroma. You can temporarily relieve the pain by taking off your shoes, flexing your toes and rubbing your feet.
Other causes of foot pain can be confused with Morton's neuroma. A wart on the ball of the foot can cause pain, for example. So can inflammation of a sheet of tissue called fascia (FASS-cha) beneath the skin on the underside of the foot. Inflammation of tissue around the joint (capsulitis or bursitis), or inflammation of one of the foot bones, can also cause pain. A doctor makes the diagnosis of Morton's neuroma by pushing directly on the spot between the third and fourth toes where it forms.
Treatment usually starts with switching to shoes that have wide toe boxes, low heels and good arch support. A foot-care specialist may also recommend an adhesive pad to fit under the front of your foot. Custom-made shoe inserts, or orthotics, can correct any structural foot problems that might contribute to nerve compression.
You can also relieve painful inflammation by icing the area or taking nonsteroidal anti-inflammatory drugs such as ibuprofen, naproxen or aspirin.
Occasionally, a foot specialist will inject the area with a steroid and anesthetic to reduce inflammation and numb the pain. This can't be repeated very often, because the treatment can damage the tissues, but it can give you temporary relief.
Inflamed or injured nerves can take time to improve. But if your pain continues despite several months of treatment, your doctor may recommend surgery. Surgery can remove the neuroma or create a wider space for the affected nerve to travel through.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)