A Morton’s neuroma is non-traumatic in nature and is more specifically fibrosis around the nerve in the interdigital space rather than a true neuromatous process. It is thought to be due to an entrapment neuropathy due to a tighter space, such as tight fitting shoes causing reduction of the space between the metatarsal bones. They occur more commonly in females and 85-90% are in the third web space. Typically people experience aching or pain in the third web space, especially after standing for longer periods. They may develop reduced sensation in the 3rd and 4th toes.
Usually involve pain on the plantar (sole) of the foot especially with activity and walking, it may radiate to the toes and it is relieved by rest and removal of shoes, especially tight fitting shoes. There may be a long history of symptoms.
Weight-bearing X-rays. Ultrasound or MRI scans may be required
- Non Operative Treatment:
- Topical pain creams e.g. NSAIDS
- Pain medications e.g. NSAIDS such as Mobic or Panadol Osteo
- Footwear modification: wide toe boxed shoes, soft metatarsal bar
- Activity modification: improve fitness and strength via non axial loading exercises e.g. cycling,
swimming. Avoid axial loading exercises e.g. running
- Injections: local anaesthetic/steroid. Some patients have relief for <2 years.
Considered if symptoms are progressing after a trial of non-surgical treatment.
This is performed as an open procedure via a small incision on the top of the foot to excise a portion of the nerve.
- Surgery Risks
All surgery has risks involved, however every effort is made to reduce these risks. Risks include but are not limited to:
- Infection: superficial wounds or deep infections
- Clots: DVT (deep venous thrombosis) or PE (pulmonary embolus)
- Nerve damage: tingling, numbness or burning
- Ongoing pain
- Stiffness of the ankle joint
- General or anaesthetic risks including to the heart and lung
- Drug reactions/allergy
- Scarring or tethering of the skin
- Calf weakness
- Revision surgery
- Increased risk of surgery in diabetics, smokers, significant peripheral vascular disease, severe neuropathy, previous or current infection which may preclude a patient from surgery
- Post Op Guides
- Ankle Arthrodesis
- Ankle Arthroscopy
- Ankle Fracture
- Calcaneal Fracture
- Flatfoot Reconstruction
- Hallux Rigidus – Arthrodesis
- Hallux Rigidus – Arthroplasty
- Hallux Valgus Surgery
- Lapidus Procedure
- Lateral Ligament Instability
- Midfoot Arthrodesis
- Midfoot Fractures Surgery
- Subtalar Joint Arthrodesis
- Tibiotalocalcaneal Fusion
- Total Ankle Arthroplasty