Hello again from Amelia White

Welcome back to Foot Facts. The Universal Portal to the wide world of feet.

This week's topic is Neuroma, Morton's Neuroma. What is Neuroma? I'll tell you.

A neuroma is a benign tumor of a nerve. Morton's neuroma is not actually a tumor, but it is a thickening of the surrounding tissue of the nerve that leads to the toes. The thickening occurs as the nerve passes under the ligament that connects the metatarsals (toe bones) in the forefoot. Morton's neuroma typically develops between the third and fourth toes, usually due to irritation, trauma or excessive pressure. The risk for Morton's Neuroma is eight to ten times greater in women than in men.

Most people with Neuroma complain that it feels like they're walking on marbles in the ball of their foot. Since this is not really a tumor, there aren't any visible signs like lumps. There is a burning pain that stretches from the ball to the toes and it gets stronger when shoes are worn, and activity is heightened. There are also reports like those of numbness or uncomfortable feeling in the toes.

Runners sometimes feel pain as they push off from the starting block. High-heeled shoes put the foot in a similar position to the push-off and can also aggravate the condition. Tight, narrow shoes also aggravate this condition by compressing the toe bones and pinching the nerves, which make the pain almost unbearable.

During your doctor visit, your podiatrist will feel for a mass or a "click" between your bones. They'll put pressure on the spaces between the toe bones to try to target the pain and look for calluses or evidence of stress fractures in the bones that could very well be the cause of pain. Range of motion tests will rule out arthritis or joint inflammations and 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 non surgical and relatively simple. They can involve one or more of the following treatments:

• Changes in footwear - Avoid high heels or tight shoes. Wear wider shoes with lower heels and a soft sole. This enables the bones to spread out and may reduce pressure on the nerves, giving them time to heal.
• Orthoses - Custom shoe inserts and pads also help relieve irritation by lifting and separating the bones, reducing the pressure on the nerve.
• Injection - One or more injections of a corticosteroid medication can reduce the swelling and inflammation of the nerve, bringing some relief.

Several studies have shown that a combination of roomier, more comfortable shoes, nonsteroidal anti-inflammatory medication, custom foot orthoses and cortisone injections provide relief in over 80 percent of people with Morton's Neuroma. If conservative treatment does not relieve your symptoms, your orthopaedic surgeon may discuss surgical treatment options with you. Surgery can reset a small portion of the nerve or release the tissue around the nerve, and generally involves a short recovery period.

As always, thanks for stopping by, and I hope to find you here next week for more on the latest Foot 411!