Morton's neuroma is a painful condition that affects the ball of the foot, most commonly the area between your third and fourth toes. Morton's neuroma may make you feel as if you are standing on a small stone or a marble in your shoe. Typically patients get shoe pain and feels better “out of shoes than in shoes”.
Morton's neuroma involves a thickening of the tissue around one of the nerves leading to your toes. In some cases, Morton's neuroma causes a sharp, burning pain in the foot. Patients also get toe pain and their toes also may sting, burn or feel numb. They may get burning in the feet . Mortons neuroma can also lead to Metatarsalgia.
The treatment of a neuroma is by wearing wide fitting shoe, avoiding a high heel, wearing a pad or orthotic support in the shoe, and occasionally, the use of cortisone injections into the affected area. These treatments are often effective.
If these conservative treatments fail to alleviate or eradicate the symptoms, then surgery with removal of the nerve is an option. Operation can be done under G.A or Local Anaesthetic block very successfully as a day case procedure.
By removing the nerve, the pain in the front of the foot and in between the toes invariably decreases, although there is numbness in between the toes which is present and which is permanent.
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome is a painful foot condition in which the main nerve supplying the foot called tibial nerve is compressed as it travels through the tarsal tunnel. This tunnel is found along the inner leg behind the medial malleolus (bump on the inside of the ankle).
Patients with tarsal tunnel syndrome typically complain of numbness in the foot radiating to the big toe and the first 3 toes base. They also complain of pain, burning, electrical sensations, and tingling over the base of the foot and the heel. Depending on the area of entrapment, other areas can be affected. If the entrapment is high, the entire foot can be affected as varying branches of the tibial nerve can become involved. Ankle pain is also present in patients who have high level entrapments.
Tinel's sign is a tingling electric shock sensation that occurs when you tap over an affected nerve. The sensation usually travels into the foot but can also travel up the inner leg as well.
MRI - MRI can assess for space occupying lesions or other causes of nerve compression.
Ultrasound can assess for synovitis or ganglia.
Nerve conduction – A test, which measures the electrical conduction of the nerve over the ankle can also help with the diagnosis.
Treatment of Tarsal Tunnel Syndrome includes rest, physiotherapy and analgesics. Rest entails immobilization of the ankle in a brace, boot or a cast. In certain conditions aggravated by an excessive flat foot an orthotic arch support is helpful.
If these treatments do not relieve symptoms, surgery (Tarsal Tunnel Release) may be performed. An incision is made behind the ankle and a ligament that compresses the nerve is released. This decreases the pressure on the nerve by the overlying ligament. Following surgery a removable boot is worn for approximately four weeks. Physical therapy will decrease the swelling and scarring over the nerve.