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If
you sometimes feel that you are "walking on a marble,"
and you have persistent pain in the ball of your foot,
you may have a condition called Morton’s neuroma. 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.
It occurs as the nerve passes under the ligament connecting
the toe bones (metatarsals) in the forefoot. Morton’s
neuroma most frequently develops between the third and
fourth toes, usually in response to irritation, trauma
or excessive pressure. The incidence of Morton’s neuroma
is 8 to 10 times greater in women than in men.
Signs
and Symptoms
Normally, there are no outward signs, such as a lump,
because this is not really a tumor. The chief complaint
is usually burning pain in the ball of the foot that
radiates into the toes. The pain generally intensifies
with activity or wearing shoes. Night pain is rare.
There may also be numbness in the toes, or an unpleasant
feeling in the toes. Runners may feel pain as they push
off from the starting block. High-heeled shoes, which
put the foot in a similar position to the push-off,
can also aggravate the condition. Tight, narrow shoes
also aggravate this condition by compressing the toe
bones and pinching the nerve.
Diagnosis
and Treatment
During the examination, your physician will feel for
a palpable mass or a "click" between the bones. They
will put pressure on the spaces between the toe bones
to try to replicate the pain and look for calluses or
evidence of stress fractures in the bones that might
be the cause of the pain. Range of motion tests will
rule out arthritis or joint inflammations. X-rays may
be required to rule out a stress fracture or arthritis
of the joints that join the toes to the foot.
Initial
therapies are nonsurgical and relatively simple. They
can involve one or more of the following treatments:
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