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PATHOLOGY PERSPECTIVES Resources Gonzalez, Peter and Richard Bowman. Morton Neuroma. Medscape. Available at http://emedicine.medscape.com/ article/308284-overview (accessed April 2009). Lowe, Whitney. 2003. Orthopedic Massage: Theory and Technique. Philadelphia: Elsevier. 66–69, 72–74. Mayo clinic staff. Morton's neuroma. Mayo Foundation for Medical Education and Research. Available at www.mayoclinic.com/ health/mortons-neuroma/DS00468 (accessed April 2009). Wheeless, Clifford and Jan Van der Bauwhede. Morton's neuroma: interdigital perineurial fibrosis. Data Trace Internet Publishing. Available at www.wheelessonline.com/ortho/mortons_neuroma_ interdigital_perineural_fibrosis (accessed April 2009). Ganglion Cyst Usually seen on the hands, ganglion cysts are pouches that grow on tenosynovial sheaths. If such a growth occurs on the tenosynovial sheaths of the toes, it could create symptoms very similar to Morton's neuroma, but the treatment strategy would have to be different. TREATMENT OPTIONS Morton's neuroma is treatable, but as with so many things, treatment tends to be most successful if it is initiated early in the process. Noninvasive strategies are often successful. These can include changing footwear to flat, well-supported shoes, or using specially designed orthotics or pads to cushion the metatarsal heads. Careful stretching of the foot, calf, and hamstrings can also help, as the nerve fibers can be caught anywhere along their distance. Finally, many people get good relief with massage: even an informal foot rub can temporarily resolve symptoms. neuroma can offer great relief. Work that emphasizes making space between the metatarsal heads will probably be the most effective. Go Where It Isn't Massage and stretching to the entire posterior aspect of the leg can have a profound affect on the functioning of the nerves that terminate in the toes. From the gluteals and deep lateral rotators to the hamstrings and all the plantar flexors (gastrocnemius, soleus, tibialis posterior, and the deep toe flexors), massage can reduce muscle tension and release fascial restrictions—both of which can allow the affected nerve tissue to move and work more freely. The prognosis for a person with If noninvasive interventions aren't successful, however, then Morton's neuroma patients may have to explore other options. Corticosteroids may be injected into the area of the fibrosis to try to dissolve excessive connective tissue. If nerve pain is intractable, the nerve may be permanently deadened with an alcohol injection. The thickened structure may also be surgically removed, but of course the consequences for this type of foot surgery include permanent numbness, muscle atrophy, and risk of infection. MASSAGE FOR MORTON'S NEUROMA This is one condition where a careful massage strategy can yield important and lasting results. Several tactics can be considered in using manual therapies for Morton's neuroma. Go Where It Is In other words, as long as sensation is present and nothing aggravates the pain, massage directly in the areas affected by Morton's Morton's neuroma is usually excellent— especially if massage is used as part of a treatment strategy—and it is refreshing to be able to discuss a condition where massage can have such an obvious and directly observable benefit. It is important to remember that this article was written in the context of our own occupational hazards. Massage therapists and bodywork practitioners who are on their feet for many hours a day are well-advised to take extra care with the quality of their footwear and to invest in what we all know is more than a self-indulgent treat. In case you haven't had one lately, let this article be a catalyst: go get a massage! teaches several courses at the Myotherapy College of Utah and is approved by the NCBTMB as a provider of continuing education. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2009), now in its fourth edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com or wernerworkshops@ruthwerner.com. Ruth Werner is a writer and educator who visit massageandbodywork.com to access your digital magazine 115