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Morton’s neuroma

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What is a Morton’s neuroma?

A Morton’s neuroma is an enlargement and inflammation of a nerve in the “ball of the foot”.

What causes a Morton’s neuroma?

A Morton’s neuroma is caused when a nerve in the foot, that runs to the toes, becomes repetitively trapped in the “ball of the foot” (between the metatarsal heads) during walking and standing, causing the nerve to become swollen and inflamed. Factors that contribute to irritation of the nerve include: abnormal foot mechanics, tight calf muscles and inappropriate footwear (narrow toe box or high heeled shoes).

What are the symptoms of a Morton’s neuroma?

The symptoms of a Morton’s neuroma are pain in the “ball of the foot” and numbness or tingling in the toes, which is usually worse while walking or standing. It can feel like a pebble moving around under the “ball of the foot” and occasionally causes a clicking sensation. A Morton’s neuroma generally occurs between the second and third or third and fourth toes. The condition can get worse with time as the nerve becomes larger.

How is a Morton’s neuroma diagnosed?

A Morton’s neuroma is diagnosis made on your symptoms and clinical examination. A foot X-ray is usually obtained to exclude other common causes of pain in the “ball of the foot” (metatarsalgia). An ultrasound can be performed to confirm the size and location of the Morton’s neuroma.

What is inter-metatarsal bursitis?

Inter-metatarsal bursitis is when an inflamed fluid filled sac (bursitis) forms between the long bones in the foot (metatarsals) or in the ball of the foot (metatarsal heads). The symptoms, causes, diagnosis and treatment options are similar to a Morton’s Neuroma.

What are the treatment options for a Morton’s neuroma?

In the first instance simple treatment measures are recommended to try and reduce your symptoms. These can have significant benefit and help avoid having surgery. Listed below are some of the main first line treatments for Morton’s neuroma but it is not exhaustive.

  • Appropriate footwear with a wide toe box and thicker soles. Avoid high heeled shoes.
  • Orthoses (medical insoles) can be useful in improving foot function and reducing pain. You can be referred to the Orthotist for a specialist opinion.
  • Activity modification by reducing activities that cause symptoms of pain
  • Stretching exercises to the calf muscles can reduce pressure through the “ball of the foot” whilst walking and standing.
  • Injection therapy with a steroid injection can sometimes improve pain by reducing inflammation around the nerve. You may decide on a repeat injection, but more than two to three injections are generally not recommended.

Morton’s neuroma surgery would only be considered an option as a last resort after non-surgical treatments have failed, and would depend on the extent of your symptoms and medical co-morbidities. Surgery is not without risks and has an associated recovery period. Please see separate information leaflet on Haglund’s syndrome surgery.

Wellbeing Advice

Patients that have a healthy diet, take regular exercise and refrain from smoking prior to surgery are more likely to experience quicker and better recovery with a more successful outcome from their surgery.

If you have any concerns about your general health and well being (diet, exercise, smoking cessation) you are encouraged to discuss this with your GP, who will be able to provide advise on the options available to you.