Morton ‘s neuralgia is a neurological condition that typically affects the forefoot. The condition is also known as Morton’s neuroma.
What is Morton’s neuralgia?
The so-called causal pain of Morton’s neuroma is localized between the second and third but also between the fourth and fifth toes. Morton’s neuralgia usually only occurs on one foot, but cases have also been described in which both feet are affected.
Morton’s neuralgia is characterized by so-called neuralgic pain. Affected patients describe these pain attacks as electrifying, burning, shooting and stabbing. In addition, the vast majority of those affected describe pain that radiates down to the tips of the toes of the affected foot. See fun-wiki for What is Leukodystrophy used for.
Morton’s neuralgia is caused by the neuroma, which is a nerve growth, a fibrous nerve thickening extending from the ball of the foot between the metatarsal heads and branching internally into the toes. At these branches, just between the second and third or the fourth and fifth toe, the benign nerve tumor forms, the neuroma.
Causes
The reason for the pronounced thickening of the nerve cord is an endogenous protective mechanism for enveloping 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 out in fine ramifications all the way to the individual toes, where they further branch and divide and finally end as fine nerve fibers on the inside of the toes. The exact causes that lead to Morton’s neuralgia are not clearly known. However, there are a number of factors that are suspected of promoting the disease. In addition to the genetic predisposition of weak connective tissue, high heels, splayfoot, narrow, sturdy shoes or heavy strain on the feet from constant long walking or standing are risk factors.
Biomechanical dysfunction from flat feet also appears to cause Morton’s neuralgia. Flat feet, on the other hand, are often the result of being overweight for years.
Symptoms, Ailments & Signs
Morton’s neuralgia initially manifests itself through non-specific numbness or strange feelings in different parts of the body. Typical abnormal sensations include “pins and needles” in the toes and a foreign body sensation in the shoe. These sensations are often accompanied by pain, which can vary depending on the severity and localization of the disease.
Stress-dependent pain is possible, which subsides immediately after taking off the shoes, but also stabbing pain, which lingers for a long time. However, symptoms generally improve when the patient sits down or removes shoes and socks. In addition, the sick are less resilient and often have to take breaks.
The pain usually occurs on one side, in a few patients the symptoms can be felt in both feet. The pain itself is described by sufferers as stabbing or throbbing. Externally, Morton’s neuralgia can be recognized by any malformations.
A splayfoot can be present, which can be diagnosed based on the abnormal position of the toes. Morton’s neuralgia sets in over a period of several months and slowly resolves with appropriate treatment. If there is insufficient therapy, the symptoms increase and secondary diseases such as metatarsalgia develop.
Diagnosis & History
The diagnosis is initially based on the collection of the medical history, anamnesis, and querying the risk factors. If, for example, tight, narrow shoes are the cause of Morton’s neuralgia, the feet had no opportunity to roll forwards due to a forefoot part that was much too narrow.
This leads to nerve compression, meaning the nerve is permanently pinched between the bony structures and becomes inflamed as a result. Morton’s neuralgia can also be an occupational disease if the job requires constant long walking or standing in the wrong footwear. If high heels are the cause, then the body weight is constantly shifting to the forefoot and this can gradually lead to splayfoot.
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
Patients with Morton’s neuralgia primarily experience problems in their feet. The feet can hurt and be affected by severe swelling. The pain can also occur in the form of rest pain and lead to sleep disorders or other sleep disorders at night. As a result, patients often suffer from psychological complaints or depression and the quality of life is significantly reduced by Morton’s neuralgia.
The patient’s resilience also decreases and there are restricted movements and gait disorders. Severe pain occurs, especially when exerting pressure. Morton’s neuralgia does not heal on its own, so medical treatment of this condition is definitely necessary. A misalignment of the foot can also occur. If the nerve is pinched, the feet can also be affected by paralysis and other sensory disorders.
A causal treatment of Morton’s neuralgia is not possible. However, the symptoms can be alleviated with medication and special shoes and insoles. Complications usually do not occur and the patient’s life expectancy is not reduced by Morton’s neuralgia. Not all complaints can be limited in every case, so that the patients may be dependent on the therapies their entire lives.
When should you go to the doctor?
Pain in the foot that is not directly related to overload or physical exertion should be examined and treated by a doctor. If the pain increases, medical attention is needed. Due to possible side effects, you should generally refrain from taking painkillers until you have consulted a doctor. A sudden and stabbing pain in the foot is characteristic of Morton’s neuralgia and should be presented to a doctor without delay.
If the physical stress limit drops, if there is a decrease in performance or if the person concerned suffers from restricted mobility, a doctor is needed. A doctor should be consulted if the pelvis is out of alignment, the body is crooked, or there are other abnormalities in the skeletal system. Without an early correction, the affected person faces lifelong damage and complaints. If the daily demands can no longer be met as usual, if behavioral problems occur and general well-being decreases, medical help should be sought.
In the case of optical changes in the foot, special features of the skin and disorders of the blood circulation, a doctor’s visit is advisable. Sensitivity and sensory disorders, numbness or irregularities in relation to temperature influences in the foot should be examined and treated by a doctor.
Treatment & Therapy
A strictly causal, i.e. cause-related treatment of Morton’s neuralgia is not possible because the exact cause of the disease is not known to this day. In most cases, however, a remedy can be found through individual knowledge of the risk factors.
However, since Morton’s neuralgia tends to become chronic, these favorable factors must be avoided permanently after the diagnosis has been made. In milder cases, no therapy is usually required. However, Morton’s neuroma should always be treated when pain occurs, activities can only be carried out to a limited extent, there are difficulties in wearing shoes or the ability to walk is already restricted. In principle, Morton’s neuralgia can be treated conservatively or surgically, depending on the severity and severity.
In the vast majority of cases, a conservative therapy is tried first before a 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 intended to relieve the forefoot when walking. Regular foot exercises or injecting local anesthetics directly into the affected areas of the foot are also suitable for pain relief.
If all conservative measures do not bring lasting pain relief, an operation is unavoidable. The neuroma, i.e. the benign nerve tumor, can be completely removed. However, even after the operation, it cannot be ruled out that the tumor will grow back in the same place.
Outlook & Forecast
The prognosis for Morton’s neuralgia is very individual with conservative treatment. Very often, however, a noticeable improvement can be achieved with the simplest relief measures. The feeling of pain can occasionally still occur in the patient, but then only with heavier loads. If Morton’s neuralgia has progressed so far that a persistent stabbing pain is 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 a few 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 more than once in a lifetime. Accordingly, no one is completely out of therapy for this after therapy. There appear to be certain factors that increase the risk of recurrence.
In any case, what permanently relieves 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. This results in permanent freedom from pain.
Prevention
Targeted foot gymnastics, foot baths with anti-inflammatory agents, and elevation of the legs are necessary to prevent the recurrence of a Morton’s neuroma after a successful operation, which should also be practiced from time to time during the day.
General prevention includes the consistent avoidance of risk factors that would favor the occurrence of Morton’s neuralgia. These include comfortable shoes that are not too tight, avoiding or reducing obesity, reducing heavy loads caused by walking or standing for too long and strengthening the connective tissue in the case of a genetic disposition.
Aftercare
In most cases, those affected with Morton’s neuralgia have only limited follow-up measures available. The person concerned should first and foremost consult a doctor at an early stage so that there are no further complications or other complaints for the person concerned. The sooner a doctor is consulted, the better the further course of the disease.
Therefore, the affected person should contact a doctor at the first sign of the disease. Most patients are dependent on a surgical procedure, which can relieve the symptoms permanently. After such a procedure, the person concerned should definitely rest and take care of his body. Efforts or physical and stressful activities should be avoided in order not to unnecessarily burden the body.
Physiotherapy or physical therapy measures may also be necessary, although the person concerned can also carry out many of the exercises at home to speed up the treatment. Even after a successful intervention, regular check-ups and examinations are important in order to monitor the current condition of Morton’s neuralgia. As a rule, this disease does not reduce the patient’s life expectancy.
You can do that yourself
The disease shows a worsening of the course of the disease in patients who suffer more from 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 to be successful. In addition, it is helpful if everyday life is structured in such a way that as little restlessness or excitement develops as possible. Conflicts and disagreements should be avoided or clarified constructively so that there is emotional relief. A fundamentally positive basic attitude towards life and the living conditions is helpful in overcoming the impairments. If possible, reduce the intake of painkillers or use them only temporarily. The active ingredients of the drugs trigger side effects and there is a risk of dependency. Relief of the symptoms can be achieved using alternative healing methods or the relaxation techniques described.
Obesity should be avoided in patients with Morton’s neuralgia. A healthy and balanced diet can provide the organism with all the necessary vitamins and nutrients. Ideally, the weight should be in the normal range according to the specifications of the BMI. Gaining weight or being overweight leads to a deterioration in health, as pain and restricted mobility increase.
