FOOT & ANKLE

Morton's Neuroma

Morton’s Neuroma refers to a nerve injury between the toes, usually the third and fourth toes, which causes pain and thickening of the nerve tissue. This thickening can lead to various levels of pain or discomfort in the forefoot that may limit your ability to perform certain activities. Morton’s Neuromas are around eight times more common in women than men and typically affect people between the ages of 30 and 60, though they can occur outside of this age range as well.

Symptoms

Common symptoms of Morton’s Neuroma include:

  • Persistent burning or sharp pain in the ball of the foot may radiate (spread out) into the toes, especially during weight bearing activities like running or walking. 
  • Sensation of having a pebble or marble under your forefoot as you walk.
  • Pain typically between the base of the third and fourth toes
  • Possible numbness or unpleasant tingling in the toes
  • Wearing high-heeled or narrow shoes squeezes the toe bones and worsens these symptoms



Causes

Compression or chronic irritation of the digital plantar nerve is the main cause of Morton’s Neuroma. Excess pressure is exerted on the nerves due to narrowing of the gap between the toe bones. Compression of the nerve in the web space may trigger swelling and cause abnormal tissue to form in and around the nerve.

Diagnosis

Diagnosis is made by medical consultation and examination, taking the patient's past medical history and palpation of the foot between the toes may reveal a thickened and tender area. An X-ray may be requested to rule out stress fracture or arthritis.



Treatment Options

Non Operative Treatment

Early treatment is critical to relieve pain. Mild to moderate cases of Morton’s Neuroma can be managed by conservative treatment. Severe cases of neuroma may require surgery. 

 

The conservative treatment measures include: 

  • Rest - rest and application of ice over the inflamed area can help reduce pain and swelling
  • Changes in footwear - choose wide toe box, lower heel, soft sole shoes to minimise discomfort between the toes
  • Orthoses - custom shoe inserts and metatarsal pads/bars may help relieve irritation by changing the location of the forces on the forefoot and separating the bones reducing pressure on the neuroma
  • Injection - Corticosteroid can help reduce swelling and inflammation of the nerve. Sclerosant injection (alcohol ablation) to cause chemical destruction (sclerosis) of the fibrous nerve tissue. 
  • Pain killers (paracetomol or panadol osteo) and anti-inflammatories if tolerated and not contraindicated


Surgery

Surgery is considered as the last option if symptoms fail to resolve with the conservative treatments. Other indications include factors such as age and activity level of the individual, and extent of damage to the nerve.

 

Surgical treatment involves resection of the compressed nerve (neurectomy) or surrounding tissue to relieve symptoms.

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