Morton's neuroma

Morton's neuroma is a painful condition that affects the ball of your foot, most commonly the area between your third and fourth toes. One of the nerves in the foot becomes thickened and gets compressed causing pain and discomfort. Morton's neuroma may feel as if you are standing on a pebble in your shoe or on a fold in your sock.

It is usually common in patients who are keen runners or standing on their feet for long periods of time. It may also be exacerbated by wearing tightly fitting footwear.

You may initially experience a tingling sensation in the space between your toes (most commonly between the 3rd and 4th toes), which gets worse over time. This eventually develops into a sharp shooting or burning pain at the base of your toes. There may also be some numbness in your toes. Localised pain is felt on the underside of the forefoot under the affected plantar nerve.

• High heels. Wearing high-heeled shoes or shoes that are tight or ill fitting can place extra pressure on your toes and the ball of your foot.
• Certain sports. Participating in high-impact athletic activities such as jogging or running may subject your feet to repetitive trauma. Sports that feature tight shoes, such as snow skiing or rock climbing, can put pressure on your toes.
• Foot deformities. People who have bunions, hammertoes, high arches or flatfeet are at higher risk of developing Morton's neuroma.

Morton’s neuroma can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition and by conducting a physical examination.

The main feature on examination is often pain when squeezing the forefoot, thereby compressing the neuroma. There may be a click felt when squeezing the forefoot (a “Mulders click”) which helps confirm diagnosis.

If there is diagnostic doubt, an ultrasound or MRI scan may be performed to clarify the diagnosis.

Most of these foot conditions improve if you reduce activities that exacerbates them. However, this may not always be practical. There are some other measures that can help with reducing your symptoms.

Non-surgical management

In the majority of cases, the symptoms of Morton’s neuroma can be managed effectively by non-invasive measures as described below.

Footwear. Wider shoes and foot pads (morton's dome), which fit inside your shoe and help reduce pressure on the nerve. These can be purchased over the counter.

Corticosteroid injection therapy. For individuals with Morton’s neuroma who continue to suffer significant symptoms in spite of using appropriate footwear and orthotics (outlined above), a corticosteroid injection can be offered as the next line of treatment. You can read more about local corticosteroid injections here

Surgical management

Surgical removal of the painful and compressed neuroma is an effective option for patients who:

• Have trialled a course of non-surgical management without success
• Have consistent, disabling pain which limits walking distances

Although surgery is usually successful, the procedure can result in permanent numbness in the affected toes.

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Surgery involves removal of the tissue by making an opening between your toes.

It can be carried out as a daycase under anaesthetic. You will walk with a pair surgical shoes for 2 weeks and you will be invited to attend a follow-up appointment.

There are some risks associated with surgery, however these are small. There is a small risk of wound infection, developing clots in your leg or lung, swelling of your foot and ankle for up to to 3 months or more, over sensitivity of scar, injury to any of major nerves or blood vessels around the area of surgery, temporary or permanent numbness around the area of surgery.

In very rare occasions you may have chronic pain as a result of surgery (CRPS), loss of limb and anaesthetic risk. However, these risks are very rare. Please discuss this further with your surgeon.

You should get back to most of your normal activities including driving at 2-4 weeks. It is normal to have some discomfort and swelling for up to 3 months