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Morton’s neuroma

What is a Morton's neuroma?

This is a painful condition affecting a small nerve in the foot. It occurs when the five long bones that run the length of the foot get pushed together, pinching the nerve in between. This friction on the nerve causes it to thicken and inflame causing pain. The condition gets its name from an American surgeon, George Morton.

Symptoms

  • Morton’s neuroma is a progressive condition which means the symptoms typically get worse over time.
  • Initially people often complain of a tingling or numbness at the base of their toes - typically in the space between the third and fourth toes, or, less commonly , between the second and third toes  – which feels  a bit like pins and needles.
  •  Over time the pain progresses and can feel like a stabbing or burning sensation in the ball of the foot under the toes. Some describe it as feeling as if they are standing on a stone. Normally the pain will get worse when you wear tight fitting shoes. Doing exercise that impacts on the foot such as jogging can also make the symptoms worse.
  • The extent of the pain varies from person to person but in some cases it can be so intense that every step can feel acutely painful.

What causes it?

The exact cause is as yet unclear. However there are a number of theories

  • Some expert s believe   problems with the design of the foot makes some people more prone to Morton’s neuroma.  Having flat feet or a high arch for example encourages the foot to slide forwards which can put excess pressure on the metatarsals. Bunions and hammer toes also increase the likelihood of developing Morton’s.
  • However simply  wearing high heels or any form of tight shoes that put pressure on the bones in the feet can also lead to a Morton’s .
  •  Typically the condition comes on between the age of 40 and 50. It is far more common in women than men – three out of four sufferers are women.

Diagnosis

In some cases your doctor will be able to feel the Morton's as a swelling in the middle of your foot. However they may also suggest an X-ray or a blood test – this is normally to rule our other causes of the pain such as arthritis. The most accurate way to diagnose Morton’s itself is with magnetic resonance imaging (MRI) or ultrasound.

Treatments

  • The first line of treatment is to try modifying footwear. Often simply wearing broader fitting shoes can reduce pressure on the neuroma and so reduce pain. Orthotic inserts can also help as they can again help reduce pressure on certain parts of the foot. Padding and taping the toe area is another option.
  • In some cases a steroid injection into the foot may be suggested. This can be done as a day case without the need for anaesthesia and helps reduce inflation of the nerve.  It can halt the pain in round 70 % of cases. Sometimes a combination of alcohol and local anaesthesia may be injected as this helps reduce pain.
  • If symptoms do not respond to any of the above measures then surgery may be suggested. This involves a short 30 minute operation to either remove tissue to take pressure off the nerve or to remove the nerve causing the pain. The surgery can be done as a day case but it will be two or three weeks before you can be fully active on your feet. There may be some lingering numbness afterwards if the nerve is removed. But surgery is successful in around 80% of cases. There is a small risk of complications such as infection and thickening of the skin on the soles of the feet.

Long term complications

If left untreated Morton’s neuroma will not cause any long term damage to the foot. But it can make every day activities such as walking or even pressing on the foot pedal in the car uncomfortable - even painful. That is why it is normally advisable to try and treat the condition or reduce the symptoms.

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