Morton Neuroma: Causes, Symptoms, and Diagnosis with Ultrasound Scans – Benefits of Ultrasound-Guided Injection

Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the second and third intermetatarsal spaces, which results in the entrapment of the affected nerve. If you have a Morton’s neuroma, the affected nerve is thickened and swollen. This can make it painful or hard to walk. You’ll usually feel pain on the ball of your foot, between your toes. It might feel like there’s a stone in your shoe or you’re stepping on a marble, which may limit weight-bearing activities and footwear choices.

Is Morton’s neuroma a tumor?

The term “neuroma” in Morton’s neuroma can be somewhat confusing. Neuromas are benign tumors that develop on nerves in various parts of the body. They involve the growth of additional nerve tissue alongside your normal nerve.

A Morton’s neuroma is not a new tissue formation on a nerve in your foot. It’s not actually classified as a tumor. Rather, it is the existing nerve tissue that becomes swollen and thickened. Morton’s neuromas do not indicate the presence of cancer. Additionally, they are not associated with causing cancer.

What does Morton’s neuroma pain feel like?

Pain from Morton’s neuroma is often described as sharp, stinging, or burning. It may also feel as though you’re stepping on an object. You might experience sensations like:

• A bunching of your sock inside your shoe.

• A tiny stone lodged in your shoe.

• Feeling as if you’re stepping on a marble or rock beneath the ball of your foot.

Symptom:

• Pain between your toes when you stand or walk.

• Pain that’s worse when you wear high-heeled shoes or stand on the balls of your feet.

• Swelling between your toes.

Causes of Morton Neuroma

Several factors contribute to the development of Morton neuroma, including:

• Tight or high-heeled shoes can increase pressure on the forefoot.

• Activities that place repetitive stress on the foot, such as running or dancing, can contribute to nerve thickening.

• Conditions like flat feet, high arches, or bunions alter foot mechanics, increasing susceptibility to neuroma.

• Direct trauma to the foot may lead to nerve irritation and inflammation.

Certain health conditions that affect your feet might make you more likely to develop a Morton’s neuroma, including:

• Flat feet.

• High arch feet.

• Bunions.

• Hammertoes.

• Foot injuries (like from a sports injury or trauma).

Ultrasound Guided Morton’s Neuroma Injection

Role of Ultrasound in Diagnosing Morton neuroma

Ultrasound scan is a non-invasive imaging technique that uses sound waves to produce detailed images of the body's soft tissues. It is particularly useful for diagnosing Morton neuroma.

Advantages of Ultrasound

1. Providing real-time visualization of soft tissue structures.

2. Detecting nerve thickening and inflammation.

3. Differentiating Morton neuroma from other conditions like bursitis or metatarsalgia.

4. Offering a non-invasive, radiation-free method for diagnosis.

Role of Insoles for Long Term Management of Pain Relief

Exercises and custom insoles are essential in managing Morton’s neuroma by improving foot mechanics, reducing nerve pressure, and enhancing overall comfort. Strengthening and stretching exercises help maintain proper foot alignment, while well-fitted insoles provide cushioning and support, relieving pain and preventing further irritation. Integrating these simple yet effective solutions into daily routines can significantly improve mobility and quality of life.

Ultrasound-Guided Injections for Pain Relief

Ultrasound-guided injections use imaging to precisely deliver medication directly into the affected area of Morton’s neuroma. This technique enhances accuracy, minimizes complications, and improves the therapeutic outcome compared to blind injections.

Benefits

1. Enhanced Precision: Ensures accurate placement of medication at the affected site.

2. Minimized Risk: Reduces the likelihood of complications by avoiding critical structures.

3. Improved Pain Relief: Direct delivery of corticosteroids or anesthetics enhances treatment efficacy.

4. Non-Surgical Approach: Provides a minimally invasive alternative before considering surgery.

Conclusion:

Morton neuroma is a common yet painful condition that can significantly impact daily activities. Ultrasound imaging enhances diagnostic accuracy, while ultrasound-guided injections offer a highly effective, targeted treatment approach. Additionally, exercises and custom insoles play a crucial role in managing symptoms by improving foot mechanics, reducing pressure on the affected nerve, and enhancing overall comfort. By combining these conservative measures with advanced techniques, healthcare providers can improve patient outcomes and provide relief with minimal risks.

References:

1. Mak, M. S., Chowdhury, R., & Johnson, R. (2021). Morton's neuroma: review of anatomy, pathomechanism, and imaging. Clinical Radiology, 76(3), 235-e15.

2. Matthews, B. G., Thomson, C. E., Harding, M. P., McKinley, J. C., & Ware, R. S. (2024). Treatments for Morton's neuroma. Cochrane Database of Systematic Reviews, (2).

3. Di Caprio, F., Meringolo, R., Shehab Eddine, M., & Ponziani, L. (2020). Morton’s Neuroma: Pathogenesis, Clinical Aspects and Current Treatment Concepts. Foot and Ankle Surgery, 26(7), 717-725.

4. Pascual Huerta, J., & García Carmona, F. J. (2023). The Role of Imaging in Diagnosing Morton’s Neuroma: A Systematic Review. Journal of Foot and Ankle Research, 16(1), 105-112.

5. Logan, K. J., & Elliott, A. D. (2022). Efficacy of Ultrasound-Guided Injections in Foot and Ankle Disorders. Clinical Radiology, 77(5), 420-428.

6. Edwards, S. R., Fleming, S., & Landorf, K. B. (2021). Efficacy of a single corticosteroid injection for Morton's neuroma in adults: a systematic review. Journal of the American Podiatric Medical Association, 111(4).