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Our consultant foot and ankle surgeon, Mr Sam Singh, discusses Morton’s Neuroma – a common cause of foot pain that is most likely to affect runners or middle-aged women.
We all know of the more well-known causes of pain affecting the foot and ankle, such as Achilles tendinitis, shin splints and stress fractures. But not many will have heard of something called Morton’s neuroma.
Morton’s neuroma, also known as intermetatarsal neuroma, is the name used to describe the enlargement of one of the nerves travelling to your toes in your forefoot. It is more likely to affect women than men.
It shocks me how common they really are! Indeed, I think it’s one of the most common causes of forefoot pain – particularly in middle-aged women or runners. I probably see and treat very large numbers partly because of the demographics of my referral base, which often comprises younger athletic patients and runners. Running is a boom sport in London.
Some of the most common signs and symptoms of Morton’s neuroma include:
Morton’s neuromas develop between your third and fourth metatarsal bones and your toes or between the second and third metatarsal. Neuromas are benign, non-cancerous and often respond to conservative care methods.
For runners, Morton’s neuroma develops after continual pressure on the nerve or wearing inadequate footwear during a run. A narrow toe-box, along with a high heel, can contribute to the problem. That’s why it’s more of an issue in women. However, if men wear narrow toe-box shoes, it can easily develop.
Other factors that may contribute to Morton’s neuromas include:
The clinical diagnosis is usually the most effective way to diagnose neuromas. In the clinic, I try to duplicate neuroma symptoms by pressing on the involved nerve at various points and try to cause a clicking of your nerve that indicates nerve enlargement. It can be a painful manoeuvre but it often clinches the diagnosis. X-rays of your affected foot will not show a neuroma, as neuromas are made up of soft tissue. An ultrasound is the best diagnostic test.
Conservative treatment involves using footwear that allows your forefoot to spread. High heels cause neuromas by squeezing and stretching the involved intermetatarsal nerve across the ball of your foot and should be avoided as often as possible.
Test shoes before you buy them to see if they are appropriate for your feet. Select shoes that have a removable liner or insole and stand on the liner, noting the position of your foot. If your foot is wider than your liner, that shoe will irritate your neuroma by squeezing your metatarsal bones together.
You may need a metatarsal dome if wider shoes alone fail to relieve your interdigital neuroma symptoms. A metatarsal pad will help spread your metatarsal bones and reduce pressure on your affected nerve as it travels under the ball of your foot. This is important.
Other conservative care remedies include ice therapy and anti-inflammatory medications or supplements. If conservative care measures fail to resolve your problem, I may recommend a cortisone injection around your involved nerve to help reduce your swelling and inflammation.
Failing all that, a neurectomy may offer a solution. This a surgical procedure to remove the enlarged and traumatised portion of the involved nerve. The mild numbness after surgery rarely causes a patient problems and removes pain associated with the neuroma.
For more information regarding Morton’s neuroma and all other orthopaedic treatments, contact London Bridge Orthopaedics.
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