Morton’s Neuroma

This describes and inflammation of the nerves that serve the toes. Nerves run between the metatarsal heads and split to either side of the toes. The most common site of neural irritation is the 2-3, and 3-4th met head spaces.

It manifests as numbness in the toes, or sharp , tingling pain in the forefoot.  When the foot is squeezed across the forefoot it may elicit pain, or when the inter-metatarsal spaces are palpated, sharp pain can be found. There is often a clicking sound when the foot is squeezed as the thickened trapped nerve is push out between the metatarsal heads. There are many stages in the development of this condition and the earlier it is dealt with the better the outcome.

Neuroma is commonly blamed on tight fitting shoes or dropped metatarsal arches. These factors may play a role, but more often it relates to a foot that is not functioning as it should.

It can occur in many types of feet, it often goes hand in hand with bunion sufferers as the foot movements that create bunions are the same as those that create Neuromas. Calf flexibility loss can lead to compensatory foot movements that can irritate the nerves in the forefoot.

The Podiatrist will assess the foot mechanics and advise on appropriate streching exercises and shoe inserts or moulded orthotics. Foot mobilisation, Compex (Neuromuscular electrical stimulation) A metatarsal lift may be added to the orthotic to assist in splaying the metatarsal heads open.

Local pain relief with topical Anti-Inflammatories are useful.

Physiotherapy can assist in reducing inflammation using mobilisation, ultrasound and heat.

Cortisone injection is an option, preferably performed by an Orthopaedic Surgeon. The exact location of the cortisone application is vital to prevent damaging the nerve.

Surgery to remove the inflamed mass is an option based on the severity of the problem and its responsiveness to conservative therapy.

Surgery on its own will relieve the pain but it may also leave numbness in the corresponding toes as the nerve can be damaged during the procedure.

Surgery without a follow up biomechanical treatment may not yield the results as the condition could occur in other Inter-metatarsal spaces. Burning, sharp, tingling pain would describe the type of symptoms that occur as a consequence of a Morton’s Neuroma.