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Morton’s Neuroma

A morton’s neuroma is a benign nerve tumor. In this case tumor refers to a mass as opposed to a malignancy. The neuroma can form in the interdigital nerve of either the 2nd or 3rd web space. It is more common in the 3rd web space over all.

Symptoms can include pain radiating as far proximally as the hip or distally into the toes. Sometimes the pain is poorly localized and sometimes the pain is absent. It is very common for the pain to be so poorly localized that diagnosis may take several examinations over a period of time. If the nerve is thought of as a electrical cable the purpose of this nerve would be to transmit information from the toes to the brain. Using the same analogy a neuroma would be equivalent to concrete surrounding the nerve at a discrete point usually where the nerve divides into two branches, one to each toe. In reality it is scar tissue rather than concrete that surrounds the nerve. Pressure on the neuroma causes pain to be transmitted either distally or proximally via the cable that in reality is the nerve.

Treatment of Morton’s neuromas consist of three basic modalities. Occasionally but rarely, a pad placed between the metatarsals, just proximal to the metatarsal heads at the appropriate site can relieve some of the pain. This is effective if the pain is not severe. Occasionally an injection of cortisone can be helpful. Risks associated with the cortisone injection include discoloration and atrophy of the skin as well as atrophy of the underlying fat pad. The skin changes and atrophy are permanent changes. The cortisone injection may be ineffective or effective only for a short period of time. I found it to be somewhat helpful in treating athletes in so far as that they occasionally may get by with injection for a period of time to perform at a game, meet or race although the expectation is that it may not necessarily be a permanent solution. The third option would be surgery. Occasionally, even after surgery, a cortisone injection may be helpful to decrease the inflammation in the web space.

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