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Morton’s neuroma

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Morton’s neuroma



Introduction 

 


Morton's neuroma



 

Morton's neuroma is a condition that affects one of the nerves between the toes.

It's also known as Morton's metatarsalgia or interdigital neuroma.

In Morton's neuroma, fibrous tissue develops around the nerve, which becomes irritated and compressed. This causes severe pain on the ball of the foot and at the base of the toes.

Morton's neuroma can occur on one foot or both feet. It usually affects the nerve between the third and fourth toes, but sometimes the second and third toes are affected.

You may initially experience a tingling sensation in the space between your toes, which gets worse over time. This leads to cramp in your toes and a sharp shooting or burning pain on the ball of your foot or at the base of your toes.

The pain is often worse when walking or wearing shoes that press on the affected area.

What causes Morton's neuroma?

The pain of Morton's neuroma occurs when the nerve connecting the toe bones (metatarsal bones) becomes irritated or compressed.

The exact cause of the irritation is unknown, but it may be the metatarsal bones pressing against the nerve when the gap between the bones is narrow. This causes the nerve and surrounding tissue to thicken.

Some experts believe that a number of other foot problems, includingflat feet, high foot arches, bunions and hammer toes, may also play a role in Morton's neuroma.

When to see your GP

If you have continual tingling or persistent pain in your foot, you should make an appointment to see a podiatrist (a specialist in foot problems). Alternatively, you could visit your GP, who may refer you to a podiatrist.


about the pain and what it feels like

when your symptoms started

what type of shoes you usually wear

about your work, lifestyle and sporting activities


They may also refer you for a scan, such as an X-ray, ultrasound scanor magnetic resonance imaging (MRI) scan, to get a detailed image of the inside of your foot.

Treating Morton's neuroma

If you have Morton's neuroma, shoes with a wider toe area may be recommended. You can also take painkillers to help ease the pain. Steroid injections may also be given to treat the affected nerve.

If these treatments don't work, surgery may be needed. This involves removing the thickened tissue around the nerve (and sometimes the nerve itself) to release the pressure

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Who gets Morton's neuroma?

Morton's neuroma can occur at any age, but it usually affects people aged 40-50 years.

As tight or poorly fitting shoes is a major contributing factor, the condition tends to be more common in women, particularly those who wear high-heeled shoes.

People who play sports that involve running and those with a particular foot shape, such as high arches, are also at greater risk. 

Symptoms of Morton's neuroma 

If you have Morton's neuroma, you may initially feel a tingling sensation in the space between your third and fourth toes or second and third toes.

This is caused by irritation of the nerve between your toe bones (metatarsal bones).

The tingling will eventually lead to pain, which can get worse over time. You may also experience cramping of your toes.

The pain is usually felt as a sharp shooting or burning pain on the ball of the foot or at the base of the toes, which is often made worse when you're walking.  

Some people with Morton's neuroma feel anxious about walking or even placing their foot on the ground.

The pain is likely to be more intense if you wear tight shoes, so wearing shoes that have more room in the toe area can help. Rubbing your foot may also lessen the pain.

Causes of Morton's neuroma 

It's not always clear what causes Morton's neuroma, but several things seem to aggravate it.

These include other foot-related problems and wearing restrictive footwear.

It's thought that Morton's neuroma may be caused by the toe bones (metatarsal bones) pressing against the nerve when the gap between the bones is narrow. This causes the nerve and surrounding tissue to thicken.

Footwear

Wearing shoes that are too tight can make the pain of Morton's neuroma worse. This is because the toe bones are more likely to press on the affected nerve if your shoes are too tight.

High-heeled shoes, particularly those over 5cm (2 inches), or shoes with a pointed or tight toe area, can also compress your toes and make the pain worse. This is why women tend to be affected by Morton's neuroma more than men.

Foot conditions

Some experts believe that other foot conditions may also be associated with Morton's neuroma. This is because other conditions may cause the metatarsal bones to rub against the nerve in your foot.

Foot problems that may increase your risk of developing Morton's neuroma include:


abnormally positioned toes

high arches – where the arch or instep of your foot is raised more than normal

 low arches or no arches at all

 a bony swelling at the base of the toe

hammer toe – where the toe is bent at the middle joint 


Sporting activities

Being active and playing sport can make the painful symptoms of Morton's neuroma worse.

In particular, running or sports that involve running, such as racquet sports, can place extra pressure on the nerve in your foot, which can aggravate the problem.

Treating Morton's neuroma 

Treatment for Morton’s neuroma will depend on how long you've had the condition and its severity.

Simple non-surgical treatments are effective for some people. Others may need surgery. 

Non-surgical treatments

If Morton's neuroma is diagnosed early, treatment will aim to reduce the pressure on the affected nerve. This is usually the nerve between the third and fourth toe bones (metatarsals).

Your GP or podiatrist (foot specialist) may recommend:


changing the type of shoes you usually wear – shoes with a wider toe area may help ease the pressure on the nerve in your foot

using orthotic devices – such as a support for the arch of your foot to help relieve the pressure on the nerve 

painkilling medication – anti-inflammatory painkillers or a course of steroid injections into the affected area of your foot may help ease the pain and inflammation

numbing injections – alcohol and local anaesthetic is injected into your foot using ultrasound for guidance; studies have shown that this type of treatment is effective


Resting your foot and massaging your toes may also help to relieve the pain. You can make an ice pack by freezing a small bottle of water and rolling it over the affected area.

Cryotherapy is a non-surgical treatment where very cold temperatures are used to destroy affected nerve tissue and disrupt its blood supply. It can be used to treat Morton's neuroma but isn't widely available in the UK.

 Surgery 

Surgery for Morton's neuroma is usually a treatment of last resort. It may be recommended if you have severe pain in your foot or if non-surgical treatments haven't worked.

Surgery is usually carried out under local anaesthetic, on an outpatient basis, which means you won't need to stay in hospital overnight. The operation can take up to 30 minutes.

The surgeon will make a small incision, either on the top of your foot or on the sole. They may try to increase the space around the nerve (nerve decompression) by removing some of the surrounding tissue, or they may remove the nerve completely (nerve resection). If the nerve is removed, the area between your toes may be permanently numb.

After the procedure you'll need to wear a special protective shoe until the affected area has healed sufficiently to wear normal footwear. It can take up to four weeks to make a full recovery.

Most people (about 75%) who have surgery to treat Morton's neuroma have positive results and their painful symptoms are relieved.

 Complications 

As with all surgery, complications can occur after having an operation for Morton's neuroma. You should discuss these with your surgeon before having the procedure.

Infection around the toes and thickening of the skin on the sole of the foot (plantar keratosis), which may require further treatment, are two possible complications that can occur following surgery.

 Preventing Morton's neuroma 

Wearing shoes that fit properly and that have plenty of room in the toe area may help prevent Morton's neuroma.