Morton’s Neuroma Advice from the Specialists – Kaser Nazir (Podiatric Surgeon)

“Morton’s Neuroma is a benign overgrowth of the small digital nerves supplying your toes as they cross the ball of your foot”. Effectively, meaning that there is a lump on the nerve that you feel at the bottom when wearing shoes giving you intense burning sensation and radiating pain to the affected toes.
  • Mortons Neuroma is by far one of the most common conditions I see in my practice on a daily basis. It is also one of the most over diagnosed condition of the forefoot.
  • The anatomy in the area is complex, with joints, ligaments and tendons being involved with pain and of course nerves.
  • I strongly believe in a firm diagnosis before committing to a diagnosis and treatment plan. I often request ultrasound scan to confirm diagnosis as it can include or exclude neuroma very easily in the experienced hand. We can also see whether there is an associated bursitis and the size of the neuroma. All this provides us with information as to whether conservative or surgical treatment is more likely to work.
  • Where, I suspect that there might be more going on, I would request an MRI scan to look at local structures and exclude other diagnosis. We use Gadolinium contrast given through a vein that highlights the nerves to improve diagnosis.
  • Treatments have varied over time. Some came and went quickly with poor outcomes. It is often confusing for patients as they would obviously want to avoid an operation but this may be the most appropriate treatment for 7mm or larger neuromas. Its is often worth trying a ultrasound guided cortisone injection that can shrink the neuroma and reduce inflammatory bursa round it. Morr recently, alcohol injections became popular but they only work in 50% of cases and require 3 injections over a period of 3-6 weeks.
  • Surgical excision of neuroma remains the most successful of the treatments and can be done under local anaesthetic. There is a downtime of 1-2 weeks with limitation in activity for 6 weeks after the operation. Success of the operation is well in the 90 percentile but there are the natural risks associated with the operation.
  • The key to Morton’s neuroma lies in the correct diagnosis with the most appropriate scans.