Morton’s Neuroma

This page describes the condition of Morton’s Neuroma and the approach to this condition adopted by Mr Bowyer, at the Wessex Nuffield Hospital. Other surgeons may use variations on the techniques, for instance with regard to post-operative management. It is important that you understand what your own surgeon intends to do, and how you will be treated after the procedure.

Morton’s Neuroma is a nerve disorder in the foot that causes pain (metatarsalgia) and loss of feeling or tingling between two toes. It involves compression of the thickened nerve between bones (interdigital nerve) of the forefoot, the metatarsals, near the toes. It most often involves the space between the third and fourth toes.

• Tingling, numbness, burning, or electric shocks in the forefoot, most often involving the third and fourth toes, although it may involve any other pair of toes
• Pain and tenderness in the forefoot, usually in the sides of the third and fourth toes’ bases, especially with walking
• Pain made worse by wearing tight shoes and lessened by removing shoes
• Severe pain in the front of the foot when standing on the front of the foot (on tiptoes), such as with running, jumping, pivoting, or dancing

• Ensure proper shoe fit with good padding
• Wear arch supports (orthotics) when necessary

Expected Outcome

This condition is usually curable with appropriate treatment, and sometimes it heals spontaneously. About 50% of cases will settle with a specific insole (a metatarsal dome) and injection. Occasionally, surgery is necessary.

General Treatment Considerations

Initial treatment consists of rest from the offending activity and the use of medications and ice to help reduce inflammation and pain. Wearing soft-heeled shoes with a wide toe area may help. Cross-training with less impact of the forefoot may help reduce the symptoms. A metatarsal dome or orthotic with a metatarsal dome may help reduce pressure on the nerve and eliminate the symptoms.

Cortisone injections may be helpful in reducing the inflammation of the nerve, especially if this is combined with off-loading of the nerve by use of a metatarsal dome.

If this treatment is not successful, surgery may be necessary to free the pinched nerve. Surgery is often performed on an outpatient basis (you go home the same day) to remove the source of compression or the inflamed nerve itself. This provides almost complete relief in most patients, although persistent numbness between the toes can be expected if the inflamed nerve is removed.

• Symptoms get worse or do not improve in 2 weeks despite treatment
• After surgery you develop increasing pain, swelling, redness, increased warmth, bleeding, drainage, or fever