The frequently asked questions about Morton’s Neuroma answered

So, what exactly is a Morton Neuroma?

Morton’s neuroma is a painful swelling or irritation of a small nerve that runs between the long bones of the foot (the metatarsals). Normally this nerve is very small - the size of uncooked spaghetti - but when it becomes a neuroma it becomes thicker like a piece of small pasta. As we walk or exercise, we squash this enlarged nerve between the bones in the forefoot.

What causes a Morton’s neuroma?

The exact cause of Morton’s neuroma is not fully understood, but several factors may contribute to its development. Most of the risk factors have a common association - too much pressure on the ball of the foot.

We see it more in people who subject their forefoot to increased load (such as in runners, dancers or those wearing heels) but also in situations where the nerve gets squashed such as in pointed shoes, tight shoes or ski boots. But in other cases patients may have none of these risk factors.

What are the symptoms of a Morton’s neuroma?

What is so unique about this condition is that the symptoms vary considerably from person to person. Common symptoms include:

• Pain: a sharp or burning pain in the ball of the foot, usually between the third and fourth toes.
• Numbness and tingling: many individuals experience a sensation of numbness or tingling in the lesser toes.
• Walking difficulties: the pain may worsen while walking or wearing certain types of shoes.
• Feeling like a small pebble: some people describe the sensation of having a small pebble or a fold in their sock under their foot.

But many of my patients find it hard to reproduce or describe.

Conditions Morton’s neuroma can be confused with

The symptoms of Morton’s neuroma can sometimes overlap with other foot conditions, leading to misdiagnosis. For example, a stress fracture can also be brought on by increased running or ill-fitting shoes. Some conditions in which there is inflammation in the joints (such as rheumatoid arthritis, Freiberg’s disease or acute synovitis) or inflammation in the ball of the foot (bursitis), can mimic the symptoms of Morton’s neuroma.

How do we diagnose this condition?

An experienced clinician will often make the diagnosis clinically. Before any more invasive treatments they may use a specialist scan such an ultrasound or an MRI to confirm the diagnosis.

What are the treatment options for Morton’s neuroma:

The treatment for Morton’s neuroma depends on the duration and severity of the symptoms as well as the impact on daily activities. Several non-surgical and surgical options can help alleviate the pain and discomfort associated with this condition:

• Footwear modifications: switching to roomier, low-heeled shoes with a wide toe box can reduce pressure on the affected area.
• Orthotic devices: custom-made shoe inserts or padding can provide support, relieve pressure, and improve foot function.
• Physiotherapy: stretching and strengthening exercises can improve foot mechanics and alleviate symptoms.
• Medication: selective corticosteroid injections that are administered around the site of the neuroma may help reduce pain and inflammation.
• Surgery: if conservative measures fail to provide relief, surgical removal of the neuroma may be necessary.

What happens during Morton’s Neuroma surgery?

Morton’s neuroma surgery is usually reserved for patients who have tried at least some of the above treatments and their pain persists. It is a day surgery procedure but the surgery is intricate so it’s performed under general anaesthetic.

A small cut of around 2cm is made over the top of the foot, at the base of the affected toes. The operation involves removing the part of the nerve that is causing the pain and discomfort. The skin is stitched and the foot and ankle are then bandaged.

Why is nerve removed?

By the time a patient has come to have surgery, the nerve is usually irreversibly scarred and damaged. This nerve has very little role, it just supplies a small area of sensation between the toes. The implications of saving it with the risk of persisting pain outweigh the drawbacks of removing it.

Can Morton’s Neuroma recur?

In some cases, Morton’s neuroma can recur even after successful treatment. Factors such as continued pressure or irritation on the nerve or an underlying foot condition may contribute to recurrence.

However, the likelihood of recurrence can be minimised by good surgical technique where a long length of normal nerve is removed with the neuroma. This way if a symptomatic nerve regrowth occurs (a stump neuroma) it will be in the non-weight bearing arch of the foot.

Can I leave my neuroma untreated?

Absolutely. This is a benign condition. Chronic pain and discomfort can significantly impact a person’s quality of life, limiting their mobility and ability to engage in regular activities. The treatment aims to make your foot more comfortable. Even if the neuroma gets larger the treatment is often the same.

In conclusion:

Non-surgical approaches such as footwear modifications, orthotic devices, and physical therapy are often effective, while surgical intervention may be required in more severe cases. If you experience foot pain or suspect Morton’s neuroma, consult with a healthcare professional for an accurate diagnosis and treatment plan.

A word from Compare my Care

Sam Singh is a super-specialist in conditions of the foot & ankle. He has a particular interest in treating bunions, Morton's neuroma, ankle ligament damage, hammer toe, broken bones and achilles tendons. His reoperation rate for bunions is 1 in 700 procedures performed. This is staggeringly low.