My daughter (51) has been having severe pain in her toes ...

Greetings.

Morton neuroma (interdigital neuroma), is a perineural fibrosis and nerve degeneration of the common digital nerve. Morton neuroma is not a true neuroma, although it results in neuropathic pain in the distribution of the interdigital nerve secondary to repetitive irritation of the nerve.

The most frequent location is between the third and fourth metatarsals (third web space). Other less common locations are between the second and third metatarsals (second web space) and, rarely, between the first and second (first web space) or fourth and fifth (fourth web space) metatarsals.

Poorly fitting and constricting shoes or shoes with heel lifts often contribute to Morton neuroma. Women who wear high-heeled shoes for a number of years or men who are required to wear constrictive shoe gear are at risk.

Treatment strategies for Morton neuroma range from conservative to surgical management. The conservative approach to treating Morton neuroma may benefit from the involvement of a physical therapist. The physical therapist can assist the physician in decisions regarding the modification of footwear, which is the first step to treatment. Recommend soft-soled shoes with a wide toe box and low heel (eg, an athletic shoe). Other possible physical therapy treatment ideas for patients with Morton neuroma include cryotherapy, ultrasound, deep tissue massage, and stretching exercises. Ice is beneficial to decrease the associated inflammation. Phonophoresis also can be used, rather than just ultrasound, to decrease pain and inflammation further. Surgical excision of the area of fibrosis in the common digital nerve may be curative when conservative measures are unsuccessful.

Other possibilities to consider are:

Rheumatoid arthritis and other systemic arthritis conditions
Hammer toe
Metatarsalgia (plantar tenderness over the metatarsal head)
Metatarsal head osteonecrosis
Freiburg osteochondrosis
Ganglion cysts
Intermetatarsal bursal fluid collections
True neuromas

Please feel free, if you need further inputs.

Dr. Arun

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What is cryotherapy? Will the fitted orthotics help and if so how long does it usually take? She bought some shoes today that the orthotics fit into better and is not so tight on her feet. I forgot to mention that she also got a perscription for a pill that is for nerve pain. It wasn't Lyrica but something like it. I believe it started with a G,and was 500mg and she took it three times a day. It is quite expensive and it didn't seem to help so she quit taking it. What do you suggest she take to relieve the pain for this condition? Thank you for your help.

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I Accept your answer but I was wondering if the fitted orthotic insoles will help this condition and if so how long does it usually take. Also I forgot to mention that she also got a months supply of a medication for nerve pain, simular to Lyrica but it started with a G and was 500 mg taken three times a day. because it was expensive and didn't give her relief she quit taking them. That is when she got fitted for the insoles. What do you suggest she take for pain for this condition? Also what is cryotherapy and where would she have this done?

Greetings.

Please see the answer before this post. I think we might have crossed each other in cyberspace. Insloes and other orthosis take up to three weeks to give perceptible pain relief and results.

This was the previous post:

Cryotherapy is cold therapy which numbs the tissue around and suppose to decrease the inflammation. It is done in physical therapy centers.

Orthotics do help in long term and may take 2-3 weeks for the desired results.

Apart from routine prescription anti-inflammatory analgesics like diclofenac sodium, naproxen sodium and indomethacin (all are prescription products) some physicians may consider to start Gabapentin 100 to 300 mg.

Please let me know if you have further questions.

Dr. Arun

Edited by Dr. Arun Phophalia on November 25 2007 at 1:25am

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This communication is open till you are satisfied. I have 20 years experience of direct patient care as a surgeon, sports medicine specialist and a medical teacher. Please click accept if I had answered your question. Good feedback/bonus is welcome.