Morton’s neuroma

As you walk, a strong ligament in the foot, called the metatarsal ligament, pushes downwards, while the ground effectively pushes back up.  The digital nerve is compressed between the two, and if it is even slightly enlarged, it will cause pain.

The enlargement or swelling of the nerve can be caused by irritation to the nerve, which might be the result of flat feet, wearing shoes that are too tight or high heels, or result from an injury or trauma to the foot.

You will experience persistent burning pain in the ball of the foot.  The pain may radiate into the toes, occasionally causing numbness in the toes.  It mostly occurs between the third and fourth toes and is generally felt when you're moving about, especially when wearing high-heels or tight shoes.

There will be a distinct pain between the bones of the affected toes, which sometimes 'click' when manipulated.

A thorough examination of the foot will determine if the pain is caused by something other than Morton’s neuroma, such as stress fractures in the bones, or by calluses or bunions.  An MRI scan will ascertain if there is a tumour in the foot.  Tests on the way your foot moves can rule out arthritis or joint inflammations as the cause of pain.

It is possible to treat Morton’s neuroma with simple, non-surgical procedures including:

  • wearing wider shoes with lower heels, which allows the toes to spread out and reduces pressure on the digital nerve, enabling it to heal
  • orthotics - tailor-made inserts for your shoes which lift and separate the bones, and reduce pressure on the nerve
  • injecting corticosteroid can reduce the inflammation and bring relief from pain

If Morton’s neuroma does not respond to the above procedures, minor surgery is usually recommended.

The dorsal approach

An incision is made in the top of the foot, which means that the patient will be able to walk soon after surgery - because the stitches are not on the underside of the foot.

The surgical instruments have to be carefully maneuvered through all of the complex structures of the foot, and the surgeon will cut deep into the metatarsal ligament, reducing the compression of the nerve.

Consultants

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