Morton''s Neuroma is a common, painful foot condition that affects women more commonly than men and becomes very chronic if left untreated. The pain and numbness that affects the toes makes walking unbearable at times, necessitating people to stop, take off their shoes and massage their foot. This particular condition becomes even worse when wearing heels or narrow fitting shoes. A number of treatments are currently available to treat neuromas.
Morton''s Neuroma is a condition first described by Dr. Morton, a Viennese physician, in 1876. The condition is a result of nerves that are irritated or pinched between the bones in the ball of the foot. There are five metatarsal bones that comprise the ball of the foot. These are the long bones that extend back from the toes. Nerves course between these metatarsal bones on their way to providing sensation to the corresponding toes. If we count the big toe as number one, the most common area for Morton''s Neuroma to occur is between the third and fourth toe. The reason neuromas occur more frequently in this area is because it is the only area in the front of the foot where two nerves come together. Therefore, in this particular area, (between the third and fourth metatarsal), the nerve is double the size than any other metatarsal space.
As the particular nerve is irritated by the heads of the two adjacent metatarsal heads, the nerve becomes irritated and inflamed, over time it becomes enlarged. Walking and wearing tight shoes squeezes the two metatarsals together sending a painful sensation into the two affected toes. The sensation can be sharp, electric shock like, burning, pins/needles and/or numbness. Sometimes the pain is relieved by taking off the offending shoe and massaging the ball of the foot.
Diagnosis of Morton''s Neuroma is made by performing a simple test. The doctor will gently squeeze the foot from side to side and use a thumb to push up between the third and fourth metatarsal heads. In advanced cases of Morton''s Neuroma, there will be a snap or clicking sensation felt in the area .This is called a positive Mulder''s Sign. The Mulder''s Sign mimics what takes place in the shoe with every step. Squeezing the foot simulates the shoe and pushing up on the bottom of the foot simulates the reactive forces of the ground as it pushes against the foot with each step.
The shoes will contribute to the symptoms of Morton''s Neuroma by binding the front of the foot and compressing the nerve. Higher heels and narrow fitting shoes exasperate the symptoms by acting to increase the ground reactive forces. In advanced cases, people can also have neuroma pain in any style shoes or even barefoot.
Approximately fifty percent of Morton''s Neuromas can be effectively treated with conservative therapy. Conservative therapy includes, better fitting shoes, pads that separate the affected metatarsal bones, prescription orthotics, pure alcohol injections . While conservative treatment can sometimes relieve the symptoms, a large percentage of patients require surgical intervention. The most common surgical procedure for correcting Morton’s neuroma has been to perform a “neurectomy”. This usually consists of an incision on the top of the foot, retraction of the metatarsal bones, and removal of the enlarged nerve. This is considered an invasive surgery and patients are subjected to longer recovery periods, loss of sensation and potential complications such as stump neuromas.
After much research, it was discovered that the adjacent metatarsal heads are held together by a ligament called the intermetatrsal ligament. These ligaments tend to bring the metatarsals closer together, not allowing them to spread apart. Much like carpal tunnel syndrome in the hand, the nerves become entrapped under the ligament and become irritated. It is believed that if the adjacent metatarsal heads could move apart slightly, it would allow for less squeezing of the nerve. Releasing or cutting the affected intermetatarsal ligament allows for more space and less restriction of the nerve, especially in the third/fourth intermetatarsal space where (because of two nerves), the nerve trunk is double the size. There is also a short recovery period without the complications associated with neurectomies. This is a very safe procedure with a high success rate and it is becoming the standard care for hundreds of surgeons throughout the country.
Koby Surgical (www.kobysurgical.com) has developed precision instrumentation to allow doctors to effectively release the intermetatarsal ligament. The Minimally Invasive Neuroma Decompression (MIND) procedure is performed in the office under local anaesthetic. It involves placing the precision instrumentation in the affected area and releasing the intermetatarsal ligament. The procedure takes under ten minutes and patients walk immediately after. There is no "down time" required and patients can resume normal activities very quickly. There is minimal, if any, post operative pain and patients can walk immediately.
"The Isogard system by Koby is the technique of the decade because it is so innovative and minimally invasive..." Werber adds, "The Isogard system is remarkably simple and allows for patients to resume activities in days rather than weeks." "In this hectic world we live in, we don''t have time to be off our feet or be distracted by foot pain." The MIND procedure has a small failure rate, if this occurs the patient may opt for traditional neuroma excision.
Werber, who introduced Endoscopic Plantar Fasciotomy (EPF) to Rhode Island in 1992, using a small scope to treat painful heel spurs, has now incorporated a similar Isogard system for treating plantar fascitis (heel spur syndrome). This treatment for painful heels, which has become epidemic in men and women, is also minimally invasive and allows patients to walk immediately.