Morton’s neuroma refers to thickened tissue that develops around the nerves at the ball of the foot. Some of the symptoms of Morton’s neuroma and multiple sclerosis (MS) overlap, which can lead to confusion between the two. In addition, a person can have both Morton’s neuroma and MS, which could potentially complicate the diagnostic process.
“Has anyone been diagnosed with Morton’s neuroma?” asked one member of MyMSTeam. “I was wondering if it is connected with MS?” If you are also wondering about this connection, here is what you need to know about Morton’s neuroma and MS.
Morton’s neuroma occurs when a nerve — usually the one between your third and fourth metatarsals — becomes irritated, causing it to thicken. You may feel like you are always standing or walking on a small rock, even after you empty your shoes and check for other problems. You may also experience numbness in the affected toes or a tingling feeling like pins and needles. Some people feel a burning pain that radiates from the ball of the foot through the forefoot toward the toes.
Some of these symptoms can overlap with those of MS — particularly numbness and tingling. Neuropathic pain, also referred to as nerve pain, affects as many as one-quarter of people with MS. It occurs as the direct result of MS-related damage to the myelin sheath that forms a protective coating surrounding the nerves in the brain and spinal cord. This damage is called demyelination, and it interferes with the nerves’ ability to transmit signals to the brain. This short-circuiting results in burning, stabbing, pins-and-needles, or squeezing sensations.
If someone with MS experiences symptoms primarily in their feet, their MS could be mistaken for Morton’s neuroma. Additionally, if someone already diagnosed with MS develops those symptoms, they could be attributed to the MS alone, and Morton’s neuroma could be missed entirely.
Morton’s neuroma and MS are not believed to be directly related. Having MS is not a risk factor for developing Morton’s neuroma, or vice versa. Instead, they are two conditions that can occur at the same time and share some similar symptoms.
Morton’s neuroma may also exacerbate foot-related symptoms of MS, such as neuropathic pain. People with MS can experience foot drop, which occurs when weakness in the ankle makes it difficult to position the foot correctly while walking.
Pain from Morton’s neuroma could complicate or make MS pain worse. In addition, Morton’s neuroma may go undiagnosed or be underdiagnosed in people with MS because they assume that their discomfort comes from MS.
Morton’s neuroma is usually caused by pressure on the affected nerve. Other sources of irritation or injury could also cause the condition. For example, sports like running or other high-impact activities cause consistent pressure on the balls of the feet. Tight shoes, such as those worn for cycling or rock climbing, can also cause the condition.
Wearing high heels may lead to Morton’s neuroma, as well as foot deformities like a bunion, a hammertoe, flat feet, or high arches.
Doctors cannot look at your feet and determine whether you have Morton’s neuroma. Instead, they may perform various tests. These may involve flexing your feet and listening for clicks (Mulder’s click test) or gently squeezing the space between your toes. Clicking sounds or pain may indicate Morton’s neuroma.
Your doctor may want to confirm this diagnosis with an imaging test. Both ultrasound and MRI can effectively diagnose Morton’s neuroma. Some doctors may also perform X-rays. These tests can eliminate other causes of foot pain, like stress fractures.
If you have MS, it may be more difficult to distinguish between pain from Morton’s neuroma and MS-related pain. In many cases, imaging helps resolve any confusion quickly because the neuroma can be seen on the test. The location of your pain may also be key. MS can cause pain throughout the foot, but the pain from Morton’s neuroma is usually concentrated in the ball of your foot.
There are many treatment options available for Morton’s neuroma, including surgical and nonsurgical treatments. Any doctor who prescribes medications for Morton’s neuroma or other conditions must know that you are also diagnosed with MS. This will help them prescribe medications that are safe for you to take with your MS treatments. They may choose a more conservative treatment first to minimize complications.
Treating Morton’s neuroma often starts by improving your footwear choices. Make sure you are wearing shoes that are wide enough for your feet across the ball of the foot and that the toe box gives your toes room to spread. If you need special permission to wear such shoes at work, your doctor should be able to help you explain your medical condition.
You may need to add custom orthotics or inserts to your shoes, at least for a while. These will help remove pressure from the neuroma so it can heal. You will need to commit to wearing these regularly for them to work and follow up with your doctor if they aren’t helping.
Take the pressure off the neuroma by resting your foot. Stay off it as much as possible, and try to refrain from exercise or physical strain that may make it worse. Minimize weight bearing as much as possible.
While resting, you can put an ice pack either over or under your toes (wherever it seems most effective to you). Keep this on for 15 minutes at a time to help reduce swelling and inflammation in the soft tissue around the neuroma.
There are many kinds of injections that may help with Morton’s neuroma. The most common ones involve corticosteroids. Your health care team will work with you to determine whether you want to try corticosteroid injections and how to go about it safely and without interfering with any MS treatments.
Ethanol or alcohol injections may also be helpful and are currently being studied. There may be other options available, too. Research is ongoing as to whether these different types of injection treatments are effective.
There are several surgical procedures available for Morton’s neuroma. These are usually only used when other treatments fail or when the neuroma is severe.
Sometimes, doctors will try to remove the neuroma. There are many ways of doing this, and your doctor will choose one based on the location, size, and other details of your neuroma. Other times, doctors may try to remove pressure from the nerves in your foot without removing the neuroma, or they may perform surgery to treat another condition (like a hammertoe) with the hope that fixing it will relieve the pressure that helped create the neuroma.
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