Morton’s neuroma occurs as the nerve passes under the ligament connecting the toe bones (metatarsals) in the forefoot.
Morton’s neuroma most frequently develops between the third and fourth toes, usually in response to irritation, trauma or excessive pressure.
The incidence of Morton’s neuroma is 8 to 10 times greater in women than in men.
What is Morton’s Neuroma?
This is a condition whereby the patient develops swelling of a nerve between the toes. It is completely benign but can cause significant pain and disability. It is often exacerbated by certain footwear and impact exercise.
What are the symptoms of Morton’s Neuroma?
It is most common between the 2nd and 3rd toes but can occur in any of the webspaces. Patients will often complain of aching pain under the front of the foot after periods of standing or exercise. These symptoms can often be made worse if the patient was to wear a high heeled shoe or tight footwear. It is also common to have the sensation of constantly standing on a smooth pebble or a crease in the sock. This is due to the pressure effect of the swollen nerve. There can also be numbness of the two toes affected by the neuroma.
How is Morton’s Neuroma diagnosed?
A good history and examination by a Foot and Ankle Specialist is important in coming to the correct diagnosis. Clinical signs of a Morton’s Neuroma on examination can include an abnormal sensation of the affected toes, tenderness in the webspace between the toes, and worsening of the pain on squeezing the toes together. Definitive diagnosis and measurement of the size of the neuroma can be formally made with Ultrasound Scanning or MRI.
How is Morton’s Neuroma treated?
Simple pain killers can improve the symptoms if they are mild but more may need to be done. Changing your footwear to a more cushioned sole or wearing a shoe insert to change the contact areas on the sole of the foot can give excellent relief. Injection around the neuroma under ultrasound guidance with local anaesthetic and steroids has been shown to be an excellent way of treating the condition. If the injection wears off it can be repeated but an excessive number of injections can lead to skin damage and the effect often gets less with every repeated injection. Surgery to excise the neuroma has been shown to be an effective and safe treatment for the condition once lesser therapies have been trialled. This is a day case operation performed through a small incision on the top of the foot. Over 80% of patients are very happy with the results of the procedure.
