Mr Dishan Singh MBChB, FRCS, FRCS(Orth)

Consultant Orthopaedic Surgeon, Foot & Ankle Specialist

Morton's neuroma (inter digital neuralgia)

Morton’s neuroma is not a neuroma (nerve tumour). It is a painful swelling or irritation of the digital nerve that runs between the metatarsal bones. Entrapment of this nerve causes pain in the ball of the foot that radiates to the toes.

Morton's neuroma

Pain, numbness and a tingling sensation are the main symptoms. This usually presents when the foot is enclosed in a shoe and while standing or walking. Pain is usually experienced in a specific area of the forefoot and radiates into the toes.

The condition commonly affects the third and fourth toes and sometimes the second and third toes but may occur between any of the toes. As the condition progresses, shooting pains (like electric shocks) may be felt, even without any weight bearing. Occasionally a clicking sensation is associated with the pain.

Non-operative treatment

  • Appropriate shoes and orthotics – modifying footwear, insoles and extra wide soft shoes with cushioning to the soles often help to offload the forefoot, thus improving symptoms.
  • Injection – cortisone in conjunction with a local anaesthetic (lignocaine) injected into the area around the nerve relieves pain in about 40% of cases. Injections can also be useful in localising the site of the swelling.

Surgery

If conservative methods are unsuccessful, surgery may be necessary. The operation involves removing the part of the nerve that causes pain and discomfort. As a result, some permanent numbness will be experienced on the side of the involved toes. In a small number of patients, persistent pain occurs at the cut end of the nerve and further surgery is required - this is known as a stump neuroma. In view of this, surgery is only considered after all non-operative measures have been unsuccessful.

The aim of surgery is to relieve pain and, therefore, improve mobility.

Read more about Morton's neuroma (inter digital neuralgia):

  A patient's guide to morton's neuroma (inter digital neuralgia) 

Images used by permission of RNOH

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