Morton’s Neuroma

Morton’s neuroma is a common cause of foot pain that typically is made worse by tight fitting shoes. Most commonly the pain is felt between the 3rd and 4th toes and may be associated with numbness in these toes. Neuromas can also occur in the space between the 2nd and 3rd or, rarely, between the 4th and 5th toes. The condition is caused by swelling and irritation in one of the common digital nerves of the foot.

Treatment of Morton’s neuroma in the early stages involves the wearing of wider shoes and avoiding high heels. Most patients can be made more comfortable with this approach in combination with a custom insole that is specially designed to relieve pressure beneath the inflamed nerve. On occasion the Morton’s neuroma may be injected with cortisone if the initial treatment does not provide adequate relief of symptoms. In about fifty percent of patients symptoms persist and eventually they undergo surgery for this problem. Surgery involves excision of the swollen nerve, which results in permanent numbness of the involved web-space and adjacent sides of the corresponding toes. This surgery is often performed as a day case procedure, using a local anaesthetic ankle block in combination with intravenous sedation. The nerve is approached through the top surface of the foot and the two metatarsals are spread apart by dividing a ligament which binds them together. The

offending nerve is then removed in such a way to reduce the chance that the cut end of the nerve will form a tender stump on the weight-bearing portion of the foot. The combination of local anaesthesia, a dorsal approach and a rigid sole post-operative shoe, enables the patient to immediately fully weight-bear on the operative foot. The foot must, however, be kept elevated as much as possible during the first 2 weeks after surgery to limit the amount of post-operative swelling, bleeding and to aid wound healing. At the first post-operative visit the sutures are removed and the patient may progress into a rigid sole sandal or capacious shoe. Postoperative swelling and ache often takes 4-6 weeks to settle but can take longer in a proportion of patients. This surgery typically resolves symptoms due to the neuroma although some slight residual discomfort is common. Possible complications of surgery include; infection, wound healing problems, recurrent neuroma as well as anaesthetic and drug reactions. Approximately 20% of patients are not improved by this surgery and a small percentage can be made worse by surgery. This is an important point to consider before consenting to undergo this procedure. It is why we nearly always recommend a non-operative approach to the initial treatment of this problem.