Morton’s Neuroma

 

  • A Morton’s neuroma or fibrosis is a firm swelling or scarring on the digital nerve which runs along the foot between two metatarsals (long bones in the forefoot) and divides to supply skin sensation on the adjacent surfaces of two toes.
  • Pain is usually caused by wearing shoes when the foot is squeezed together and is often worse in raised heels.
  • Insoles (orthotics) are often not very helpful in this condition.
  • Investigations are often unhelpful.  An X-ray of the foot will not show a Morton’s neuroma. An ultrasound or MRI scan are only able to show swellings of more than 6mm and so small neuromata may not be seen on a scan.
  • A local anaesthetic and steroid injection can be useful as a diagnostic test.  Instillation of local anaesthetic around the affected nerve can abolish the pain temporarily.  This helps to confirm the diagnosis and the steroid may reduce swelling and inflammation around the nerve and improve symptoms.  This may be curative in some patients but may not work or any benefit may be temporary.
  • An operation is usually effective for the majority of patients.  This removes the affected nerve and in most patients this abolishes the pain and full function returns.  Occasionally there is some ongoing pain even after surgery.  One lasting effect is numbness in the adjacent sides of the 2 toes supplied by the nerve which is removed.  This is reported to feel like having cotton wool between the toes and does not usually cause any concern.
  • Occasionally pain may persist after surgery and a complete cure does not always occur.  Most patients have an excellent outcome however.

Morton’s neuroma operative information