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MORTON'S NEUROMA & TARSAL
TUNNEL SYNDROME
Ross Hauser, M.D.
It is quite common for people with the diagnosis of a
neuroma, or nerve
entrapment, to undergo multiple surgeries attempting to alleviate the
entrapment. One individual came to us at
Caring
Medical with a history of 15
surgeries! This occurs primarily because most physicians incorrectly believe
numbness is equated with a pinched nerve.
Ligaments and
tendon weakness in the
limb also cause chronic numbness in an extremity.
Morton's Neuroma is often diagnosed
from the symptom of burning pain in a toe or toes. This is a neuroma involving
the nerves located between the toes. These nerves allow sensation to be felt
on the skin of the toes.
Despite years of experimental research and clinical
investigation, the painful neuroma has remained difficult to prevent or to
treat successfully when it occurs. More than 150 physical and chemical methods
for treating neuromas have been utilized including suturing, covering with
silicone caps, injecting muscle or bone with chemicals such as alcohol, and
many others.
Surgical treatment has been
problematic with poor results and complications. In one study, 47
percent of the patients continued to have symptoms of foot pain after surgery.
The reason for continued symptoms after surgery or chemical injections may be
that the chronic foot pain or numbness is due to
ligament weakness and not a
pinched nerve.
 Tarsal Tunnel Syndrome
Another diagnosis used for chronic
burning foot and/or toe pain is Tarsal Tunnel Syndrome. Tarsal Tunnel Syndrome
is very similar to
Carpal Tunnel Syndrome of the hand except it involves the
foot. The tibial nerve runs in a canal on the inside of the foot called the
tarsal tunnel. When the tibial nerve gets pinched here, it is called Tarsal
Tunnel Syndrome. The symptoms described for this syndrome include pain in the
ankle, arch, toes, or heel.
Chronic burning arch, toe, or heel
pain is most often due to ligament weakness at the ball of the foot or soft
tissue weakness in the arch of the foot, rather than pinching of a nerve as in
Tarsal Tunnel Syndrome. The
ball of the foot is called the metatarsal joints and supports half the body
weight during walking.
Since these structures bear the bulk of the body weight
when a person stands, walks, or runs, it is no wonder that these are generally
the first structures to weaken. Metatarsal ligament weakness is manifested by
pain at
the ball of the feet which often radiates into the toes. This is called
metatarsalgia.
A weakened arch causes the foot to feel weak and tired
especially after a day of standing or walking. It can also radiate pain into
the big toe side of the foot. Chronic metatarsal ligament weakness and arch
weakness (also known as plantar fasciitis). Fasciitis can cause numbness in the
foot and toes in the same areas of pain. Pain and numbness in the foot can
also be caused by ligament and tendon laxity in the knee. The lateral
collateral ligament can refer pain and numbness down the lateral side of the
leg and foot and the
medial collateral ligament
down the medial side. Thus
anyone with foot pain or numbness needs to have their knees looked at to see
if there is any evidence of ligament weakness there.
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