Mortons Neuroma

This condition is characterised by a burning pain in the ball of your foot. This was apparently first described by an English Podiatrist in 1845 but ultimately named after an American surgeon in 1876.

The 'Neuroma' is a swelling of the nerve under your foot just before the toe web-space. When you walk the nerve is 'pinched' and this often causes a burning pain that in many people radiates to the toes. Wearing a narrow or high heel shoe often aggravates the pain. Sometimes the pain is due to a swollen bursa (sac of fluid) pressing on the nerve. The treatment for both conditions (Neuroma/Bursa) is often the same. The level and frequency of pain varies but often the neuroma can be present without causing any symptoms.

Investigations

Frequently the symptoms of a Mortons Neuroma are classic and the diagnosis is made clinically. If needed this is confirmed with an MRI or Ultrasound scan that images the soft tissue swelling. An X Ray does not normally provide useful information. Often to confirm the diagnosis you will have a diagnostic local anaesthetic block into the swollen nerve. This should temporarily ease the pain and is a very useful method to confirm the diagnosis.

Slide showing the thickened nerve sitting between the 3rd and 4th Metatarsal Heads

Treatment

Treatment depends on the level and frequency of pain. Wearing a wider shoe can make a significant difference but this is not always practical. Insoles can alleviate symptoms but rarely cure the pain. You might wish to try a steroid injection. In some people this can shrink the nerve and cure the pain. Unfortunately this only seems to be effective in a small number of people and the 'cure' might only be for several months but it is worth trying. There are other newer injection therapies available including injecting alcohol. Some research papers report good results but there are few long term studies to confirm this. A further method of 'freezing the wart' has been described with varying results

Surgery

Should these other therapies fail surgery is often required. Usually the swollen nerve/bursa is excised via a relatively small incision on the top of your foot near the web space. The nerve actually sits in the ball of your foot but it is best to avoid operating from the sole of your foot if possible. If you are having several nerves removed you will need several incisions. Once the nerve is identified it is carefully removed making sure that there are no nerve fibres remaining. The wound is then closed in layers. The operation takes about 30 minutes. The removed piece of nerve is sent for inspection. This is standard practice.

Picture demonstrating incision line immediately after surgery

Post operative pain is usually very mild with this kind of procedure. It is important however to rest adequately in order that the wound will heal uneventfully.

There are plenty of research papers confirming good results with neuroma surgery. There are possible complications but fortunately these are rare.