Morton's Digital Neuralgia, or neuroma, is described as pain in the ball of the foot at the junction of adjacent toes to the ball, which is usually sharp and may alternate with periods of comfort or dull pain. Associated with sharp shooting pain into the planar aspects of adjacent toes, there may be periods of numbness. More commonly, pain is referred into the medial aspect of the fourth toe and lateral aspect of the third toe. This is referred to as the third interspace. There also may be a neuroma present in the second interspace with shooting pain into adjacent aspects of the second and third toes. Really, a neuroma can be associated with an inflamed sesamoid in the first interspace. Very rarely a neuroma can be present in the fourth interspace. Neuromas usually are present in one interspace only, but may be present in adjacent interspaces; more commonly the second or third. They are more prevalent among female than male patients who are comfortable in loose-fitting footwear such as slippers or sandals, but experience acute discomfort after standing or walking some time in close fitting shoes or boots. Generally, the foot appears normal in appearance.
The diagnosis is made by placing a lubricating cream on the bottom of the foot and palpating the interspace with fingers. A clicking sensation with associated pain will be found. The patient typically states that when he walks there is a cramping, aching pain in the ball of the foot which is always better if he sits down, takes off his shoe and massages his foot.
This condition was first described by Thomas G. Morton of Philadelphia in 1876. He described several cases as an old homeopath would, symptoms such as: pain disturbing sleep; numbness with shooting, unbearable pain; pain so severe that they would welcome the foot being cut off. The sensation of rocks or pebbles in the shoe under the ball of the foot are frequent.
The neuroma is often associated with an inflamed bursa. In theses instances there are symptoms typical of bursitis such as a fullness in the bottom of the foot, or pain which may be effected by changes in the weather. Bursas typically have more of an aching sensation, where neuromas have sharper nerve pain. An inflamed bursa puts pressure on the nerve, accentuating the problem
Standard treatment consists of placing the patient in a loose fitting, softer shoe to decrease abnormal pressure. If abnormal biochemical findings are present, a form of foot support orthotic may be helpful in redistributing the weight. Classically, the pediatric community will use one to three Cortisone injections, one to two weeks apart in the involved interspace. This is done to decrease inflammation and or fibrosis. This is 60% to 70% successful, especially when a bursitis is present. In those cases resistance to conservative treatment, surgical excision is recommended. Surgery is upwards to 90% successful with 7% to 10% complications, including entrapment neuroma, stump neuroma or regrowth of the nerve with pain more severe than prior to surgery.
By far the most common remedy for stitching pain from the ball of the foot extending into the toes (biting pain) is Hypericum. Stitching pain in third toe and better cold is Ledum. Sticking pain (as from a nail) between the metatarsal bones when standing, pain on ball of feet on stepping, pains changing in character rapidly are signs which point to Berberis Vulg. Bruised pain in the ball of the foot which shoots into the toes, is worse from cold, wet weather, worse with excessive walking, worse from initial motion, and better with gentle motion all point to Ruta Grav. Ruta Grav, of course, is well known for bursal pain in the foot. Numbness alternating with pain at the ball of the foot could point towards Causticum. Causticum also helps numbness upon walking. Cramping pain on the ball of the foot extending into the toes suggests Causticum (again) and Cuprum (violent cramps). Cramping and arthritic pain on the ball of the foot extending to the toes, worse with initial motion, better with continued motion and worse with damp cold suggest Rhus Tox. or Ruta Grav.
Oral Homeopathic remedies can be most helpful and, at times, will completely resolve the problem. If the neuroma is quite large, and there is surrounding fibrosis and/or bursitis, injection therapy may be necessary. A neurolysis injection technique utilizes specific homeopathic remedies mixed with local anesthetic and Wydase (Hylauronidase) to facilitate a local aggravation while mechanically decompressing the nerve and disbursing fibrosis. Three to five injections a week apart are utilized. Appropriate oral remedies are continued. The success rate approaches 80% with this technique. Surgical excision is necessary In the 20% of the patients with advanced fibrosis and nerve pathology. With surgery, appropriate homeopathic remedies, such as Arnica help the patient recover. In the event a neuroma is exceised and a stump neuroma or entrapment neuroma develops, the homeopathic remedy Symphytum can be very helpful. One might, also, consider Staphysagria, Hypericum or Causticum.
For more information
For further information consult Dr. Subotnick's Book Sports and Exercise Injuries, Conventional, Homeopathic & Alternative Treatments, by North Atlantic Books.
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