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Morton’s Neuroma

Morton’s neuroma, or Morton’s metatarsalgia, is a condition that is relatively commonly seen by podiatrists. A typical patient would complain of pain at the ball of their foot, usually around their third or fourth toe. Sometimes they will describe shooting pain into the toes, or numbness. Typically the pain is worst when they have been standing or moving about on their feet.

The word neuroma is a little misleading for this condition. Traditionally, a neuroma would refer to a tumour comprised of nerve tissue. This is not entirely correct. A Morton’s neuroma is an inflamed or irritated nerve. At each of the gaps between the bones that make up the ball of the foot (the metatarsal heads) lies a nerve which is responsible for innervating the toes. If this gap becomes too tight, it can irritate the nerve and cause it to swell and become inflamed. When the nerve is swollen like this it can cause all sorts of strange sensations, such as pain, burning, or numbness.

There are a number of reasons why the nerve may become trapped between the bones. If the joints of the foot are very mobile, or loose, they can be more susceptible to moving around and causing compression of the nerve. The alignment of the bones can also cause compression between the bones if the feet are flat and have a tendency to roll inward (pronate). Sometimes the makeup of the foot causes a smaller gap between the metatarsal heads to have developed. It’s interesting to note that the usual place for a neuroma to form is between the third and fourth toe.

Your podiatrist can help to accurately diagnose the condition. Sometimes X-rays are required to ensure there are no other conditions causing similar symptoms. An ultrasound will usually show a thickening of the nerve between the bones.

There are a number of ways to treat a neuroma. In their initial stages they may respond to general methods to reduce inflammation, such as resting and icing the area. Your podiatrist can help you with padding methods to help open up the joint space between the toes and prevent the nerve from becoming further irritated. Sometimes orthotics are required to assist in changing the function of the foot so that pressure is removed from the area. In extreme cases, injection of corticosteroid and anaesthetic to help settle the inflammation may be required, or finally a surgical removal of the neuroma may be needed.