DeLoor Podiatry has plenty of patients who complain of stones on the ball of their foot. They say it “feels like I’m walking on marbles.”
This is common in women, particularly those who have been using high heels for a long time. But it also affects distance runners of all sexes, and dancers and athletes in high-impact sports who haven’t been using properly fitted and padded footwear to absorb the shock to the forefront of their feet.
The cause can be metatarsalgia, or Morton’s neuroma. Dr. Loor says, “We recommend coming to podiatrists immediately. Like we’ve mentioned in our other articles, foot conditions can cause complications when left untreated. The pain spreads to your hips and back. You may not be aware of it but when something is wrong with your foot, the rest of your body has to compensate.”
What is metatarsalgia and Morton’s neuroma?
Metatarsalgia is the inflammation of your metatarsals, located on the balls of your feet.
The metatarsals receives a lot of force when we run. Distance runners and other athletes–gymnasts, tennis players, volleyball players– often land on the front of the foot. An active lifestyle of walking and climbing stairs can also inflame the balls of the foot.
Dr. Albana Thomaraj says, “It’s normal to experience pain on the balls of your feet, the heels, the arch. A bit of massage and plenty of rest usually resolves the pain, right? But when the pain persists even after you’ve been good and changed your shoes and activity levels, that’s the sign of metatarsalgia.”
Morton’s neuroma, on the other hand, is an inflammation of the nerve, or a thickening of the tissue around the nerve that leads to your toes. Its symptoms are similar to metatarsalgia.
The cause and effect is a circle: metatarsalgia is metatarsal stress, which can cause fibrous growth around the nerve, irritating the nerve and causing neuroma, and a neuroma contributes to metatarsal stress, leading to metatarsalgia.
Metatarsalgia is easily treated with conservative treatments of shoe inserts, rest, supportive shoes and other measures to prevent relapse. In rare cases, or to treat an underlying cause like hammertoe, you may need foot surgery to realign your metatarsal bones.
In this article, we discuss Morton’s neuroma, the more difficult and urgent condition of the two.
Symptoms of Morton’s neuroma
Symptoms for this condition are usually pressure-related. That means that you won’t immediately experience pain when you get on your feet and start walking. If you do, that rules out Morton’s neuroma. Instead, you might have other conditions like arthritis and other injuries. See our articles for details, and for a match for your symptoms.
Aside from the headliner sign of feeling like you have a pebble in your shoe, the following symptoms are associated with Morton’s neuroma.
- Feels like you’re walking on stones, marbles, or as if you have a fold in your sock
- Persistent pain that lasts for days
- Intense, burning or stinging pain in the ball of the foot
- Intense pain that gets worse the longer you are on your feet: standing, walking, running
- Pain that disappears when you’re off your feet or when you remove your shoes, or when you switch from high heels to flats with a wide toe box
- A sharp shooting pain that seems to travel along your nerves, radiating to your toes
- Numbness and/or tingling in your toes
- A tingling sensation between your fourth and fifth toes, the location of the nerve
Morton’s neuroma causes
As previously mentioned, metatarsalgia– and its own causes– can cause neuroma, which occurs due to pressure and repeated trauma and irritation to the nerves leading to your toes.
The following conditions put you at higher risk to develop Morton’s neuroma, or might have already caused it.
- Intense training and high-impact sports that involve running and jumping subjecting the front of the feet to repetitive stress.
- Sports/activities that require tight shoes, which puts pressure on your toes: skiing, rock climbing, ballet, soccer (cleats)
- Wearing high heels
- Obesity – body weight goes to the forefoot when you walk. Excess weight means more pressure, leading to damage
- Other foot conditions that end up putting extra pressure and more weight than usual on the metatarsals, leading to inflamed nerves: high arches, splayfoot (flatfeet or fallen arches), hammer toe, bunions at the bottom of your feet
- Inflammatory arthritis: gout or rheumatoid arthritis
- Untreated stress fractures that have changed your gait and the weight-distribution in your foot
Diagnosing Morton’s neuroma
DeLoor Podiatry specialists would always talk with you about your symptoms, medical history and physical activities. Next, you would undergo imaging tests for differential diagnosis.
“We would do X-ray, ultrasound and, if needed, MRI,” says Dr. Jose Loor. “Sometimes you suspect it’s one thing but turns out to be a different kettle of fish altogether. The right diagnosis is essential for the right treatment.”
X-ray would rule out stress fractures. Ultrasound and MRI both visualize soft tissues. A swollen nerve would easily be seen from an ultrasound. When results are inconclusive, MRI confirms it, especially for patients with conflicting symptoms.
During your foot’s physical examination, your podiatrist would test your range of motion to rule out arthritis and joint issues.
Your doctor would also press between the toes and look for tender spots. Both of you might even feel the mass formed by the thickened tissue and inflamed nerve. The doctor would also look for something clicking between the toe bones of the affected foot.
Other conditions causing your forefoot pain could be:
- Stress fractures
- Warts and tumors
- Splay foot
“In those cases, it may feel like Morton’s neuroma, but it’s not. Or at least not yet. We’ll fix those conditions instead,” says Dr. Jose Loor.
Conservative treatments for Morton’s neuroma
“Treatment depends on how bad your symptoms are,” says Dr. Audrey Abetmarco. “I’ve had patients who experienced relief by changing their shoes and using shoe inserts we prescribe.”
You may have to avoid high heels forever. Look for shoes with a wide toe box, to prevent squashing your toes together. Therapy and strength training for the foot would also fix gait issues that could be causing irritation to the digital nerves of your feet.
Your treatment options are:
- Non-steroidal, anti-inflammatories (NSAIDs) for pain relief while the nerve heals
- Supportive, padded shoes to help the nerve heal
- Orthotics – custom-designed foot supports fitted to the exact shape and contours of your foot.
Injections for Morton’s neuroma
This is one of the most common treatments before resorting to foot surgery. An injection can also help DeLoor Podiatry confirm that it’s a nerve– and exactly which nerve– is causing you pain.
That’s the first option, the diagnostic anesthesia injection. “We inject the anesthetic to the nerve,” says Dr. Audrey Abetmarco. “If the patient experiences relief from symptoms, that tells us it’s not cartilage or ligament that’s causing the problem.”
DeLoor Podiatry has had patients who experience a long-duration pain relief from anesthesia alone. When these injections are given twice or thrice a week, it can even completely break the cycle of pain.
Cortisone injections, on the other hand, targets swelling. If swelling goes down, the pressure and the pain due to the pressure goes away.
Cortisones are long-acting steroids that give you relief from symptoms, whether it’s in your foot or in your knee, or all the way up in your shoulder. Your dosage and nooster injections depend on whether you are already on steroid shots in other parts of the body, and how much pain relief you get post-injection. The right doctor with the right dosage shouldn’t get you more than five shots per year.
“We mix the cortisone with an anesthesia for immediate relief up to 5 hours post-injection,” says Dr. Audrey. “And then we keep tabs on how you feel after one week, after two weeks. Within this period, you have to rest, icing your foot three times a day, no high-impact activities.”
After two weeks and you improve, you can return to previous activity. When none of these treatments work, it’s time for foot surgery.
Ligament decompression for Morton’s Neuroma in New York and Brooklyn
“Why the ligament all of a sudden? I thought we were talking about a neuroma!”
It’s connected, and it works. Ligament decompression surgery relieves the pressure on the nerve by cutting the nearby ligament that binds the bones of your foot together. The nerve is compressed or pinched– so you need decompression. This surgery accomplishes that.
It’s like the relief you feel when you switch from a tight shoe to a wider shoe.
Your DeLoor Podiatry surgeon would make a small cut below the affected toes. Through this opening, your surgeon would cut the deep transverse ligament.
This removes the pinching on the nerve, but the nerve is left alone.
Another option is If you and your podiatrist agree on nerve removal, your surgeon would also cut and remove the nerve with the neuroma. In this case, you would lose all feeling on your third and fourth toes.
That’s it. The incision is stitched and bandaged. The stitches would be removed after 2 weeks. You go home with a post-operative shoe. Dr. Jose Loor says, “Our patients usually get back to driving at 5 days. And they’re back to their regular shoes– not high-heeled– after 3 weeks.”
DeLoor Podiatry provides all-around podiatry services ranging from ankle and foot trauma, ingrown toenails, bunions and hammertoes, to advanced treatments like stem cell injections, arthroscopic reconstruction, bone stimulators and spider veins and varicose reduction. We serve patients across New York and New Jersey, including Gramercy, Flatiron, Murray Hill, Herald Square, Chinatown, Bay Ridge, Wall Street and Bensonhurst, Fair Lawn NJ. The specialists, led by Dr. Jose Loor.
, led by Dr. Jose Loor.