Morton's neuroma
Introduction
Morton's neuroma is a common, painful condition affecting the base of the toes, usually the third and fourth toes. The pain, which is sharp and severe (often described as like a red-hot needle), suddenly occurs while walking.
The pain happens because the nerve that divides between the metatarsal bones (toe bones) is irritated or compressed. The cause of this irritation is not exactly known, but it may be the metatarsal bones compressing the nerve when the gap between the bones is narrow. This causes the nerve to thicken.
It is rare for more than one nerve to be affected, and it usually only affects one foot.
Who is affected
Anyone can develop Morton's neuroma, but the condition is much more common in women. It tends to occur in women who wear high-heeled shoes, people who regularly do sports or those who have a particular foot shape, such as a high arch (see Causes for more information).
Outlook
Most people with Morton's neuroma will need surgery, which involves removing the affected nerve or releasing the pressure on it. Surgery is usually successful in treating the condition (see Treatment for more information).
Some people do not need to have surgery as their problem can be relieved by changing their footwear, taking painkillers and having a course of steroid injections.
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Symptoms
The symptoms of Morton's neuroma can occur unexpectedly and get progressively worse with time.
Pain
Morton's neuroma causes sharp or dull pain between the toes (usually the third and fourth toes).
The pain occurs while you are walking and will cause you to stop and remove your shoe. It makes some people with the condition anxious about walking or even placing their foot on the ground.
Keeping the weight off your feet or rubbing your foot can lessen the pain, which is made worse by wearing tight shoes.
Other symptoms
Other symptoms of Morton's neuroma are:
- numbness, tingling or a burning sensation in the toes, and
- the feeling that something is squashed inside the foot, or that there is a stone inside your shoe.
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Causes
The exact cause of Morton’s neuroma is not always known, although a number of problems seem to aggravate it, including:
- High-heeled shoes, particularly those over 5cm (2 inches) or those with a pointed or tight toe box, which can compress the toes. For this reason, women tend to suffer from Morton’s neuroma more often than men.
- Conditions such as a high-arched or flat foot, a bunion (bony swelling at the base of the toe) or a hammer toe (where the toe is bent at the middle joint). These can all increase the chance of Morton's neuroma occuring as they can cause the bones in your feet to rub against a nerve.
- Sport activities, such as running or racquet sports, which can put extra pressure on your feet.
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Diagnosis
Your GP or podiatrist will probably ask you:
- how much pain you are in and what it feels like
- when your symptoms started
- your work, lifestyle and hobbies
- the type of shoes you normally wear
Your GP may refer you to a podiatrist, who will normally examine your foot and feel the toes to try to locate the irritated nerve.
Your GP or podiatrist may refer you for an X-ray, an ultrasound scan or a magnetic resonance imaging (MRI) scan, to get a detailed image of the inside of your foot. An ultrasound uses high-frequency sound waves to build up a picture, while an MRI scan uses strong magnetic fields.
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Treatment
Treatment for a Morton’s neuroma depends on how long you have had the condition and its severity. Identifying the condition in its early stages will help to avoid the need for surgery.
Early treatments
Early treatments will aim to relieve or reduce pressure on the area around the affected toes. This may involve:
- A simple change in the style of shoes you normally wear. Wide-toed shoes that allow for width adjustment may be recommended.
- Padding to provide support for the arch of the foot, which removes pressure from the nerve.
- Anti-inflammatory painkillers and a course of steroid injections, which can help ease any pain and inflammation (swelling).
Pain can be relieved by resting the foot and massaging the affected toes. You can make an ice pack by freezing a small bottle of water and rolling it over the affected area.
Surgery
In more severe cases, where early treatment options have not worked, surgery may be considered. This is normally done under local anaesthetic (the area is numbed).
Surgery usually involves removing the affected nerve, which often takes up to 30 minutes and can be performed on an outpatient basis (you go home the same day). There will be some numbness in the toes afterwards.
Alternative procedures are also emerging, such as releasing the affected nerve if it is trapped or removing the pressure on it. These other methods are being tried because in about a fifth of cases, a nerve stump can regrow when the nerve is removed and the symptoms may return.
Other possible problems that may occur after surgery are:
- infection around the toes
- tenderness around the sole of the foot
Despite these possible complications, surgery is usually successful and recovery generally takes less than four weeks.
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