Morton Neuroma

In this page I want to explain what is meant by the terms "Morton's neuroma" and discuss which treatments are best and why.  I have been a Podiatric Surgeon for nearly twenty five years and in this time I have observed many different treatments come and go for many foot problems.  What's important is providing the right treatment for patients and not being sucked in by the latest "fad".  Patients deserve to be given evidenced based and tried & tested treatments.  Before I get to the boring text why not have a look at the slideshow which hopefully explains a few things.

WHAT IS A MORTON'S TYPE NEUROMA?

A Morton's neuroma is an enlarged nerve in the ball of the foot.  It is not a tumour as such and they are not malignant.  

 

WHAT CAUSES A MORTON'S NEUROMA?

.We believe that these lesions are caused by repeated minor trauma which leads to fibrosis / scarring of the nerves in the sole of the foot.  We know this because of the careful study of the neuromas removed and examined under the microscope.

WHAT ARE THE COMMON SYMPTOMS?

There are some very classical symptoms of Morton's neuroma which can aid the diagnosis.  These include:

  • Forefoot pain

  • Numbness / tingling sometimes burning 

  • Shooting pains into the toes

  • Cramping

  • Feeling like you need to remove your shoes and massage your foot

  • Feeling like there is bit of gristle in your foot when you walk

WHAT WILL HAPPEN DURING MY APPOINTMENT?

The very first thing that needs to happen is for the diagnosis to be confirmed and this is done through a very detailed history and clinical examination.  Following this you may be sent for an ultrasound or MRI scan of your foot. Mr Metcalfe will also carefully assess the biomechanics of your feet to determine if there are predisposing risk factors.

WHAT ARE THE MOST EFFECTIVE TREATMENTS?

There are a range of treatment options for Morton's type neuroma pain and Mr Metcalfe will talk you through the treatment options which are right for you.  These might include:

WHAT DOES A MORTON'S NEUROMA LOOK LIKE?

This is a picture of a Morton's neuroma Mr Metcalfe has remvoed taken during the operation.

WHY DO MY TOES SPLAY APART?

Your toes are held together by some pretty complex anatomy, a delicate balance of ligaments and tendons.  As the neuroma develops it begins to fill up the space between the toes and upsets the pull of these tendons resulting in splaying of the toes. Of course not all patients will present with this feature as the presentation of the neuroma will depend on a whole raft of different factors incliuding:

  • Size of the neuroma

  • Location (whereabouts it has formed in relation to the mtpj)

  • Flexibility of the individual

I HAVE READ ABOUT ALCOHOL INJECTIONS?

There are many treatment options for Morton's neuroma.  Perhaps one explanation for the variation in treatment is that there is no one guaranteed successful treatment.  Injections do however sound very attractive to patients who perhaps are swayed by the apparent simplicity and lack of post surgery immobilisation.

OK think of it like this; if there was really an injection that would cure all neuromas with no complications then you can be pretty sure we would all be offering this treatment.  There is no such treatment.  I am a Consultant with over twenty five years experience and get frustrated with people being less than honest about success rates.

The first thing to consider is whether the diagnosis of Morton's neuroma is correct.  The diagnosis should be made based on clinical and radiographic assessment in combination.  DO NOT consider any invasive treatment without this.  Although clinical diagnosis is very accurate in experienced hands it is essential to rule out other pathology. 

Some studies have shown alcohol sclerosing injections to have similar success rates to open surgery although multiple treatments are required.

WHAT ABOUT CRYOTHERAPY?

Just as with alcohol injections cryotherapy involves pouring liquid nitrogen (196 celcius) into the area of the neuroma.  Currently there is very little quality data on this treatment.