A Morton’s neuroma is a nerve that becomes swollen and inflamed between the bones of the forefoot. Although neuroma typically means ‘nerve tumour’, in this case it refers to the enlargement of the nerve. The swelling and inflammation arises from compression of the nerve underneath the bones of the ball of the foot, leading to pain in that area and possibly in the toes. The pain may sometimes be absent or minimal. Other symptoms include numbness in the toes, and a marble-like sensation around the ball of the foot, like there is a pebble in the shoe. Risk factors contributing to the development of Morton’s neuroma include local compression due to tight or high-heeled footwear, people who participate in activities and sports such as jogging and running, skiing and rock climbing, and patients who have foot deformities such as bunions and hammertoes. The condition tends to get worse with time and repeated injury causes the nerve to become larger, resulting in it becoming easily injured.
NON-OPERATIVE MANAGEMENT A Morton’s neuroma may be treated with non-surgical measures such as modifying shoe wear by wearing wider shoes and avoiding high heels or tight shoes to enable more room for the bones to spread out. Using an insole with a metatarsal dome or foot pads help to reduce pressure on the nerve. A cortisone injection around the nerve may provide relief by reducing inflammation and swelling. Other options such as weight loss, physiotherapy, and using simple analgesia and non-steroidal anti-inflammatory drugs (NSAIDs) may contribute to relieving pressure and pain associated with this condition. Non-surgical treatment may or may not improve symptoms. Alternative modalities include shock wave therapy .
OPERATIVE MANAGEMENT Surgery can help relieve pain and improve the functioning of the foot. A Morton’s neuroma is excised by making a cut on top of the foot between the metatarsal bones. The nerve is then identified and a short section of it is removed. Since the surgery involves removing a nerve, there will be permanent numbness in the toes. This does not usually cause too much concern and the patient notices it less with time.
POST-OPERATIVE MANAGEMENT After the operation you will have a bulky dressing on your foot, which you must keep clean and dry for two weeks until your first appointment with the surgeon. When resting keep your leg elevated as much as possible to reduce swelling.
COMPLICATIONS No surgery is risk free. The risks and complications will be assessed and discussed with you. Specifically, you will have numbness in the webspace and the inner margins of the toes, which the nerve supplied. Additional complications include swelling, bruising, worsening of pain.
