Mortons Neuroma

A neuroma is a benign growth of tissue on a nerve. The most common neuroma in the foot is an interdigital neuroma or a 'Morton's Neuroma' which most often forms between the 3rd and 4th toes, although this is not the only site for a neuroma.

The nerve becomes 'pinched' between the metatarsal heads and is swollen and painful.

There is often a 'clicking' effect which is known as Mulders Sign, but it isn't always present. The clicking is actually the nerve moving up and down between the two bones.

Patients complain of a burning or a sharp pain.  The pain can become intense, affecting every step. Sometimes pain travels forward into the toes and occasionally the affected toes become numb. The pain is often relieved temporarily when the foot is rested without footwear. The site of the pain is easily palpated and sometimes a small lump can be felt through the skin.

Mortons neuroma can be caused by the specific architecture of the foot.  For example, hammer toes may cause the metatarsal heads to take excessive pressure during the walking cycle and press against each other. A neuroma may be due to occupational factors, such as excessive kneeling which causes  an 'overpull' on the structures. It is also caused by tight footwear, especially high heels which have the same effect on mechanical structures as kneeling and hammer toes. Even flat shoes may cause the problem if the toe box squeezes the metarasal heads and causes friction.

The discomfort from Mortons Neuroma can be relieved by separating the metatarsals which can be achieved conservatively. The first line of treatment is to assess footwear and decide if one particular pair of shoes is causing the problem. If the neuroma is more established and relief cannot be obtained through a change in footwear alone, your podiatrist can help often through the use of orthotics.

A podiatrist will advise on the best orthotic for your foot, although these do require extra space in the footwear and a shoe with more room for your forefoot is still a requirement. Sometimes the problem is so painful that surgery may be required; but often, once the inflammation subsides, the problem is more easily managed.

If you think you may be suffering from Mortons Neuroma, seek professional help, today!

Involuted Nails

Here at the Footcare Clinic, we often  hear people complain of ingrown toenails. Sometimes they are ingrown, but more often they are 'involuted'.

Involuted nails can be very painful as the two sides of the nail curl towards each other pressing into the skin at the edges of the nail. Looking at the nail from the end of the toe, the nail has a profile similar to a staple, as in the picture below. Sometimes the curvature of the nail is so great that the tip of the nail curls in a circle causing the skin to be pinched. They usually they don't break the skin or become infected but they can become painful due to pressure.

It doesn't take a wild imagination to understand the problems that nails like this can cause. The nipping action of the nail makes them feel very tight and any added pressure on the top of the nail from footwear for example, can cause friction in the nail sulcus and lead to a build up of hard skin. As hard skin develops at the nail edges, the amount of pressure increases and this makes the toes more painful.  

Very often, the shape of the nail increases the total depth of the toe, necessitating a much deeper toebox in footwear. With insufficient room in the toebox, pressure on the nail causes the nail plate to thicken up, leading to increased pressure, more hard skin in the sulcus and even corns. So the circle of events continues.

Some  people with involuted nails never have any problems with them, but the liklihood of the nail pressing on the skin and becoming sore is much greater than in people with flatter nails.

The problems really occur when the pain causes people to cut their nails back in an attempt to gain relief. Sometimes this works, but only for a short period of time. Occasionally this 'self care' can leave small spikes of nail which can then penetrate the skin and  become embedded, causing an infection and an ingrown nail, ( onychocryptosis)

With involuted nails, it is important to cut them straight across the natural line of the nail. Cutting away at the sides often leads to other problems. It is also important to ensure there is sufficient depth in the toebox of a shoe, to prevent excessive downward force on the nail. Professional help is always advised.

If this becomes a long standing problem, then a simple procedure known as a Partial Nail Avulsion can help. This involves removing the side or sides of the offending nail permanently so that the nail that is left behind is flatter, easier to manage and has no curved bits to dig into the sides.