Mortons neuroma occurs when a nerve is squeezed between the third and fourth toes. It can be caused by footwear such as high heels or pointed toes. Significant pressure on the forefoot can also trigger a neuroma, such as jumping, long-term standing or sprinting.
The inflamed nerve that is being pinched between the bones of the foot can cause severe burning pain, or even a lack of feeling altogether. Other symptoms may be tingling, numbness, or cramp. Swelling will indicate the site of the benign tumour.
Self-help measures include a change of footwear, massage and ice packs. Orthotics may relieve the pressure on the nerve. Weight loss and reduction of exacerbating activities can be helpful in some cases.
Injections of either corticosteroids or alcohol reduce inflammation or sclerose (harden) the trapped nerve and reduce the pain.
If non-surgical therapies do not work, Mr. Samarji a Neuroma and Forefoot pain specialist in Manchester can carry out a procedure under local anaesthetic. Going in on the dorsal (upper) side of the foot, or the plantar (sole) nerve can be removed, or the pressure on it alleviated. The plantar approach will mean the patient will be on crutches for a few weeks after the operation as the stitches are on the bottom of the foot.
At the consultant having evaluated your foot along with investigations confirming that Morton’s neuroma is present and is causing the pain, discussion about the differing treatment options would take place discussing the pros and cons of the various options (non-operative and operative treatment). Following this type of discussion, you should be in a position to decide whether or not you wish to go ahead with an operation or whether you wish to pursue one of the non-operative options or consider an injection. Not everybody needs an operation or wishes to have an operation. The alternatives to surgery include changes to shoewear, insoles or to consider an injection. If insoles or orthotics are needed then Richard can refer you to a podiatrist with information regarding the most appropriate type of orthotic that you may need. If it has been decided to go ahead with surgery then arrangements for the operation will follow.
Surgery for Morton’s neuroma is relatively minor surgery. It is performed quite quickly and typically takes ten to twenty minutes to perform the procedure. The surgery involves removing the neuroma. The incision can be placed either on the top of the foot or on the sole of the foot. The operation is generally done under a short general anaesthetic.
Surgery for Morton’s neuroma is generally carried out as a day-case procedure. Following surgery, you will be able to walk on the foot. Arrangements are made for an outpatient appointment approximately two weeks following the operation to remove the stitches.
Following Morton’s neuroma surgery, it is usually possible to get back to work after approximately seven to ten days. For the first few weeks, it is important not to do too much to allow the wound to heal. Getting back to a more manual job would be at approximately three weeks following the surgery. Return to playing sports would be at approximately six weeks following the procedure.
Physiotherapy is not usually needed following surgery for Morton’s neuroma.
All surgery carries risks and these include infection, clots, mild numbness around the tops of the toes, tenderness in the scar and complex pain. The risks are small but need to be taken into account in any decisions for the operation and this pertains to all surgery.