What Is Morton's Neuroma?
Interdigital neuroma (Morton’s Neuroma) of the foot includes common, paroxysmal, neuralgia affecting the web spaces of the toes. It involves entrapment neuropathy (nerve compression) of the common digital nerve below and between the metatarsal heads, typically between the third and the fourth metatarsal heads. The pain is most commonly felt between the third and fourth toes but can also occur in the area between the second and third toes.
What Causes Morton's Neuroma?
The cause of this problem is often due to impingement of the plantar nerve fibres between the metatarsal heads and the intermetatarsal ligament. It is entirely a biomechanical phenomenon.
The commonest reason for this is due to natural substances present in between the metatarsal heads and between the fat pad and the intermetatarsal ligament. These natural substances i.e. bursa, fat, capsular thickening and even bony growths, can all be a factor in the impingement process and may need to be surgically cleared.
Symptoms to Look Out For
Symptoms of interdigital neuroma typically manifest as a sharp, burning or tingling sensation in the forefoot. The pain radiates toward the lesser toes and is aggravated by shoe wear. The pain is relieved when the shoe is removed and the forefoot is massaged. Sometimes the symptoms involve specific toes.
How Is Morton's Neuroma Diagnosed?
The diagnosis of interdigital neuroma is usually made by physical examination and review of the patient’s medical history. MRI and High Definition Ultrasound examination may be useful to confirm the diagnoses however they may still not be 100% reliable.
Differential diagnoses include stress fracture, capsulitis, bursitis or ligament injury at the metatarsal-phalangeal joint, a tendon sheath ganglion, foreign-body reaction and nerve-sheath tumour.
Conservative Treatment Options
Conservative treatment involves a reduction in the inflammation and removing the impingement factor. Reduction in inflammation is achieved via rest, elevation, ice, and massage with anti-inflammatory gels. Removing footwear and/or wearing broad type footwear would also help. Injection therapy is useful in reducing symptoms.
Injection therapy to the forefoot, from the clinic’s own image library.
Show clinical images
When Symptoms Persist
Majority of publications including peer review journal articles, surgical technique description and textbooks promote surgical excision as a gold standard treatment. Surgical excision is described as the most definitive mode of treatment for symptomatic Morton’s neuroma. Reported outcomes vary between studies, and your surgeon will go through what the evidence supports for your case at your consultation.
Various surgical techniques are described, essentially categorised as dorsal versus plantar incision approaches. Beyond this, the commonest technical variation described as influencing the outcome of surgery involves burying and anchoring transected nerve into soft tissue such as muscle.
What is involved in neuroma surgery?
Surgery to excise the neuroma is usually performed under general anaesthetic in a day surgery facility. After surgery, you will have to keep your foot dry for two weeks. Generally, neuroma surgery allows for early weight bearing and protection in some type of post op shoe gear. Some neuromas may reoccur, but this is rare. Because the nerve is removed, permanent numbness in the affected toes is an expected result rather than a complication. Your surgeon will talk through the likely outcome, the risks and what the published evidence shows before you decide.
Why the operation sometimes fails
Interdigital neurectomy is the removal of the diseased nerve. Some of the reasons behind failure is when not enough nerve is dissected, mistakes in initial diagnosis, or bad handling of adjacent nerves, tendons and joint capsules during the operation. It is very common and acceptable to have some numbness in the area where the nerve used to be. This never causes any discomfort and often gets better in a few years.
After surgery
It is crucial to address the biomechanical pathologies underlying the impingement of the nerve during and after the surgery. Ozan will work closely with your Podiatrist in providing appropriate orthotic therapy to address these biomechanical issues.
Morton's Neuroma FAQs
The pain is most commonly felt between the third and fourth toes but can also occur in the area between the second and third toes. The pain radiates toward the lesser toes and is aggravated by shoe wear.
The pain is relieved when the shoe is removed and the forefoot is massaged. The cause of this problem is often due to impingement of the plantar nerve fibres between the metatarsal heads and the intermetatarsal ligament.
The diagnosis of interdigital neuroma is usually made by physical examination and review of the patient’s medical history. MRI and High Definition Ultrasound examination may be useful to confirm the diagnoses however they may still not be 100% reliable.
It is very common and acceptable to have some numbness in the area where the nerve used to be. This never causes any discomfort and often gets better in a few years.
Surgery to excise the neuroma is usually performed under general anaesthetic in a day surgery facility. After surgery, you will have to keep your foot dry for two weeks. Generally, neuroma surgery allows for early weight bearing and protection in some type of post op shoe gear.
Serving Manly and the Northern Beaches.
Manly Foot Clinic is at Shop 3/3 Corrie Rd, North Manly, NSW 2100, and treats Morton’s neuroma for patients from Manly, Dee Why, Brookvale, Freshwater and Balgowlah. The clinic is open Monday to Friday from 8:30am to 5:30pm and Saturday from 8:00am to 2:00pm.