A neuroma is a benign tumour of a nerve. A Morton’s neuroma is not a tumour, but the thickening of the tissue that surrounds the nerve that leads to the toes. Pain may occur in the ball of your foot, which radiates to the toes. The good news is that you can relieve the pain felt from the condition with a few nonsurgical treatment options. Here, one of our expert orthopaedic surgeons Mr Paul Hamilton explains all.
What is Morton’s neuroma?
A Morton’s neuroma is one cause of metatarsalgia, which is a medical term for the pain that is felt in the ball of the foot. It is due to the inflammation and subsequent thickening of the tissue that surrounds one of the nerves leading to the toes.
The inflammation is caused by irritation, trauma or increased loading of the nerve underneath the bones of the ball of the foot. Neuroma means nerve tumour. Tumour in this case means simply an enlargement of the nerve and does not relate to malignancy or cancer. Often neuromas can be associated with inflammation of small fluid-filled sacs (bursitis) that are present in the foot and act as cushions.
What has it been described as feeling like?
The symptoms of Morton’s neuroma are usually a pain in the ball of the foot, which may shoot down the toes and occasionally there might be a feeling of numbness.
At times, the pain may be absent and at other times severe enough to cause the individual to stop and take off the shoe. It may feel like walking on a marble or stone. Tight shoes, high heels and pushing off the starting blocks when running, may aggravate symptoms.
How do you diagnose a neuroma?
The diagnosis of the neuroma can often be made from the description of the symptoms but can be challenging. The examining doctor can sometimes feel a neuroma by pressing on the foot. The key to diagnosis and therefore treating a neuroma correctly is by an accurate diagnosis.
Callosities (hard skin) under the foot and toe deformity (clawing or elevation of the toe off the ground) make the diagnosis less likely and other cases of metatarsalgia should be looked for. If there is any doubt about the diagnosis then a review by an orthopaedic surgeon specialising in foot and ankle surgery is recommended prior to treatment.
Can they be seen on X-ray?
X-rays can be helpful to rule out other diagnoses but neuromas cannot be seen on an X-ray. Ultrasound is a useful diagnostic tool to confirm the presence of a neuroma, but do not confirm the diagnosis as they may be an incidental finding and may not be the cause of the pain. MRI scan can be used to confirm the diagnosis and is often used to rule out other causes of pain.
Is Morton’s neuroma permanent?
Treatments that reduce the inflammation and load in the forefoot can allow neuromas to become asymptomatic (no pain). It is recommended to try conservative treatment options prior to surgical treatment options.
How can be it treated?
Initial treatment should be non-operative and aim to reduce inflammation and the load across the foot and can be successful in up to 80% of cases. These may include:
- A short course of anti-inflammatories.
- Calf stretches to reduce the forefoot pressure.
- Wide fitting shoes to prevent compression of the nerve.
- Custom insoles often combining a medial arch and metatarsal dome to reduce the pressure on the nerve.
- Steroid injections can be done under ultrasound guidance.
If conservative treatment fails then surgery can be considered. This aims to remove the nerve and thus relieve the pain. Since a nerve is removed, there is permanent numbness in the toes afterwards. This is not usually a problem and it becomes less with time.
You can book an appointment with Mr Hamilton via his Top Doctor’s profile here if you would like his expert opinion on your case. Can’t make the appointment in person? Mr Hamilton is available for a video call using our e-Consultation tool, which can also be found on his profile.