Effective Treatments for Morton’s Neuroma

Morton’s neuroma is a condition of the foot where the digital nerves that run in between the metatarsals become damaged over time. This can be as a result of excess traction, stretching of the nerves or compression of the nerves caused by footwear or sports. Essentially, the nerve becomes thickened and develops fibrous changes which results in scarring.

Symptoms of Morton’s Neuroma

Common symptoms include burning pain, tingling and numbness into the toes. Often patients report a lump-like feeling or walking like there’s a pebble in their shoes that is not present. If one develops a neuroma, it can often be debilitating and not allow certain activities and needs specialist intervention and advice.

Risk factors include high heels, tight shoes, repetitive stress, and some genetic factors where you have a wide foot with deformities such as bunions and hammer toes causing crowding of the toes.

Non-surgical Treatments for Morton’s Neuroma

Footwear Modification

One can use wider shoes using an insole inside the shoe to spread the load. A Morton’s dome to spread the metatarsal can cause some offloading of the stress on the Morton’s neuroma, reduce traction and prevent spreading of the foot.

Activity and Lifestyle Adjustments

One could reduce certain shoes which are tighter at the front in the toe box that cause impingement, using heels less often and even flat ballerina type shoes less often can help.

Medication

Anti-inflammatory medication such as non-steroidal medication can help for temporary measures but are not a long-term management. One could perform an injection into the neuroma under some guidance to reduce the swelling. This can work in some cases especially when there’s inflammation around the nerve.

Physiotherapy and Exercise

Stretching the calves, reducing the loading of the foot and strengthening the toes can help.

Surgical and Advanced Treatments

Types of Surgery

The types of surgery usually include either removal of the neuroma, called the neurectomy procedure. This is a small surgical procedure performed as a day case under local anaesthetic or sedation. The nerve is removed, which results in numbness between the toes, but resolves the pain. The neuroma is not affecting a functional nerve or more remote nerve, therefore it does not affect your function. It is very successful with long-term success rate of 95% in most cases. Patients can return to all types of footwear and sports after.

Other surgical treatments using minor techniques can involve decompression where you remove the scar tissue around it. However, this is not really proven in the literature to be as successful as a complete removal of the nerve. More recent cryosurgery seems to work in some cases, but it may not be a long-term solution.

Recovery and Rehabilitation Post Surgery

Typically wound healing will take two weeks, and you will be walking carefully no more than 10-15 minutes in a post-op shoe for the first two weeks. After two weeks you can transition to trainers and maybe return to sports at about six weeks in most cases. Normal walking can be resumed at about three to four weeks post-operatively.

When to Visit a Podiatrist or Foot Surgeon?

It is important to visit a podiatrist or foot surgeon at the earliest point where it’s causing you symptoms and ultrasound or MRI scan may be required to diagnose the problem. There may be many other reasons why you have pain in the foot. If treated early, sometimes appropriate footwear, orthotics, and injection can abate the problem and prevent surgical intervention.

Conclusion

Treated early, most can be managed conservatively, but if it is established or if an ultrasound is greater than 5 mm, surgery may be the only solution. Surgical neurectomy has the best evidence, also known as a Morton’s neuroma excision.

Frequently Asked Questions

What is the most effective treatment for Morton’s neuroma?

The most effective treatment is either footwear modification with insoles in the early stages, injection if that does not resolve, and surgery to remove the neuroma is by far the more permanent treatment.

What is the latest treatment for Morton’s neuroma?

We are decompressing and often using cryosurgery now, which can help, but the evidence is limited. Excision of the neuroma is by far the best evidence-based treatment.

Can you get rid of Morton’s neuroma without surgery?

You can manage the symptoms in most cases, and in some cases, conservative injection therapy can work.

What will a podiatrist do for Morton’s neuroma?

They will often diagnose it appropriately with ultrasound or MRI and clinical examination. They would most possibly start you off with insoles and injection in the first instance and will perform surgery if needed.

Where can I get my Morton’s neuroma treated?

This can be done at London Foot and Ankle Surgery. Mr Nazir is a specialist foot surgeon who performs the surgery regularly with high degree of patient satisfaction.