Morton’s Neuroma

September 12, 2017

A Morton’s Neuroma is a swelling of one of the nerves in the ball of the foot. Typically you will know you have a neuroma if you start to experience pain in the ball of your foot. People describe the pain as shooting, numbness, burning or stabbing. It is intermittent, meaning that it comes and goes. Generally, the pain gets worse with time. At first, the area may become a little bit numb for a few minutes in a pair of tight shoes, but this could develop over weeks or months to the point where you have intense stabbing pain in the foot every time you stand or walk for more than a few minutes.

There are several theories on what causes a neuroma. However, the cause is not well understood and there is very little evidence to suggest a consistent cause. What we do know is:

The swelling is thought to be from trauma of the nerve i.e. pressure from surrounding bones
The swelling is benign, not cancerous
It is more common in women
It is made worse by certain shoes or activities

Diagnosis

A diagnosis of a neuroma can often be achieved by a podiatrist by taking a thorough history of symptoms and a range of clinical examination tests. A podiatrist can also differentiate your condition from a range of other common and more rare causes of pain in the ball of the foot. Achieving a correct diagnosis is very important in formulating the correct treatment plan for you.

Most neuromas affect the area behind and between the third and fourth toes. However, they can also affect the second and third toes and more rarely the fourth and fifth toes. Diagnostic imaging tests are sometimes required if the diagnosis is not clear enough from a clinical examination alone. The most common imaging test is an ultrasound which can help aid the diagnosis if required. It is important to mention that sometimes the neuroma cannot be detected with an ultrasound machine and therefore an alternative test may be considered such as an MRI.

Treatments

There are many treatments available for neuromas. Here at Hatts, we can support you with the following:

Injection therapy – Sometimes an injection of steroid and local anaesthetic into the neuroma and around it, can relieve the pain and stop the neuroma from developing.

Orthotics – These can be of benefit when alleviating pressure from the nerve. To assess whether this is a viable option, a podiatrist will perform a biomechanical assessment and gait analysis to help determine whether an orthotic may be a suitable treatment for you.

Footwear choice – This is the simplest. If your neuroma only hurts when you dance in your favourite 4-inch heel Jimmy Choos, then take them off to dance. This is a ‘no-brainer’ and can stop your neuroma from getting worse.

After having seen one of our podiatrists, if necessary we can also refer you on for:

Surgery – When the pain warrants it, you can have the neuroma removed by a small operation. This is often done under local anaesthetic in an outpatient setting.

Cryosurgery – This is a new treatment and is used as an alternative to the traditional surgical method of excision. This procedure is less invasive and involves putting a small needle through the skin and into the neuroma which is frozen whilst it is in the foot. This is done under local anaesthetic. The success rate of this procedure seems to be equivalent to surgical excision and is thus, gaining increased popularity. There is only a small amount of clinical research compared with the excision option, therefore it is currently unknown whether there is a better option at present.