Morton's neuroma

Presentation

• Patients usually complain of pain under the ball of their feet, often described as like a “pebble in my shoe”.
• There may be pain radiating into their toes and altered sensation.
• Morton’s neuroma is a swelling of the digital nerve, most often between the 3rd and 4th metatarsal heads.

Investigation

Your GP should initially request these investigations:

• Weight bearing foot X-ray (AP, oblique and lateral)

Your surgeon may also request the following investigations for more information or surgical planning:

• Ultrasound + injection of local anaesthetic and steroid if neuroma identified
• MRI

Conservative Treatment

Initial treatment of Morton's neuroma could include:

• Orthotics with a metatarsal dome may relieve discomfort.
• Injection with local anaesthetic and steroid relieves symptoms in ~40% patients

Surgical Treatment

Surgical treatment of Morton's neuroma includes:

Excision of neuroma

• Dorsal incision in relevent webspace
• Neuroma identified and excised - sent to histology for confirmation
• Wound closed with non-absorbable stitches
• Foot bandaged and placed in Darco MedSurg flat shoe

Condition specific risks include:

1. Recurrence
2. Persisting pain
3. Wound problems

General risks of surgery include:

1. Infection
2. Damage to nerves/blood vessels
3. DVT / PE (blood clots)
4. Anaesthetic risks

Recovery

Recovery from Morton's neuroma surgery will include:

• Keep foot elevated as much as possible, especially for initial 72 hours
• Keep dressings dry and intact until post operative appointment.
• Pain killers may be required for up to 2 weeks.
• Removal of stitches: 10-14 days at first post operative appointment.
• Protected weight bearing for 2 weeks in flat DARCO shoe.
• Recommencement of most activities: 4-6 weeks. Full recovery: 3-6 months.

Every patient’s recovery is individual and depends on the severity of the injury and the complexity of the surgery.