What is Morton’s Neuroma?

Morton’s Neuroma is a condition that causes pain under the ball of the foot. Tissue around one of the nerves leading to the toes causes a sharp, burning pain in the foot and can also cause the toes to feel numb, to burn or to sting.

Mr Simon W Sturdee explains more about Morton’s Neuroma, treatment and the complications associated with surgery to remove the neuroma (nerve).

What causes Morton’s Neuroma?

There could be several causes that lead to Morton’s Neuroma, but the most common is trauma to the nerve that leads to the toes.

It occurs most often between the 3^rd and 4^th toes (70%), but can also be between the 2nd and 3rd toes. Symptoms are typically worse with high-heeled shoes or narrow pointed shoes that squeeze the nerve between the bones at the front of the foot. Many people experience relief when they switch to lower heeled shoes.

What symptoms are typical of Morton’s Neuroma?

The main symptoms associated with Morton’s Neuroma are pain and numbness in the ball of the foot. People often experience a sharp burning pain that can radiate to the toes. Some patients describe it as similar to having a stone stuck in your shoe or as if there’s a fold in your sock.

Are some people at greater risk?

Some factors that can contribute to Morton’s Neuroma include:

• High heels: ill-fitting, tight shoes that have heels can put a lot of pressure on your toes and feet, leading to trauma.
• Some sports: high-impact sports like running can subject the feet to repetitive trauma. Shoes that must be worn for skiing or rock climbing can damage the foot and put pressure on the toes, leading to nerve damage.
• Foot deformities: people with bunions, high arches or flatfeet are at a higher risk of developing Morton’s neuroma.

How is it diagnosed?

Diagnosis is usually made based on the symptoms of the patient and with a clinical exam. If symptoms are atypical, the doctor may arrange to have an ultrasound scan or an MRI scan. These scans are particularly good at detecting soft-tissue abnormalities like neuromas.

How is Morton’s Neuroma treated?

The first line of treatment is modifying footwear so that shoes have extra space around the toes. An insole can sometimes help to relieve pressure or arch supports.

Local anaesthetics and steroids can help patients. If done without imaging about 50% of patients improve with an injection. A steroid injection can damage other important structures in the foot. For this reason, it’s is preferable to do an injection with ultrasound which increases the success rate to about 70%.

If the above treatments are not effective, surgery is the only option. Around 95% of patients have a good outcome with good pain relief following surgery. The operation involves removing part of the nerve, so will leave the person with some numbness in their toes. After the surgery, a rigid soled shoe must be worn for about two weeks until the foot has healed, after which you can begin to wear comfortable flat shoes.

What are the potential complications of surgery?

Complications with surgery for Morton’s Neuroma include recurrence. This is because a neuroma can develop where the nerve has been cut and if it develops near the sole of the foot, the foot can feel very tender and require further surgery.

If you or someone you know suffers from foot or heel pain, you can get in touch with Mr Simon W Sturdee.