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Morton’s Neuroma

Morton’s Neuroma

Morton’s neuroma is one of the causes of pain under the ball of the foot. It is caused by a swelling of one of the nerves before it divides and enters the toes. The nerve involved does not supply any of the muscle that moves the toes or foot.

What is the Cause?

There are several theories but the most likely is that it is caused by trauma to the nerve as it gets trapped between the bones (metatarsal heads) in the forefoot.

This most commonly occurs between the 3rd and 4th toes and symptoms may be exacerbated by the wearing of high-heeled shoes or very narrow (Narrow toe box) shoes, as this will tend to squeeze the nerve between the metatarsal heads.

What are the symptoms?

The classic symptoms are pain and numbness in the ball of your foot. This may occasionally radiate into the toes. The pain can sometimes be absent but when severe it can cause you to stop and remove your shoes. It can be like having a stone stuck under your foot.

How is it Diagnosed?

Usually the diagnosis is made based on the clinical symptoms and signs but occasionally if these are not typical a scan may be required. This would either be an ultrasound scan or a MRI scan.

Treatment

The first treatment to try is to modify footwear so that the shoe has extra width in the toe box area. An insole can also sometimes help to relieve the pressure.

An injection of local anaesthetic and steroid can both help to confirm the diagnosis but also can help long term but only about 30 – 40% of patients get better with an injection and if the injection is not accurate then important structures can be damaged by the steroid. Usually therefore an injection is done under ultrasound guidance and this can increase the success rate to 80%.

If none of the above non-operative treatments are effective then surgery is an option. About 85% of patients are better off following surgery in terms of pain relief, 65% are entirely pain free. It is therefore not an operation to rush into, as the results are not brilliant.

The operation involves removing part of the nerve (The neuroma) and as a result you will be left with some numbness in the toes. After the surgery you will wear a rigid soled post op shoe for about two weeks until the wounds have healed. You will then be able to get into a roomy comfortable flat shoe.

Complications

Specific complications related to Morton’s neuroma surgery include recurrence. This can be because a neuroma develops where the nerve has been cut. If this is near the sole of the foot it can be very tender and may require further surgery.