Morton’s Neuroma Surgery

Morton’s Neuroma (also known as an intermetatarsal neuroma) is a benign but painful condition that arises due to the thickening of the tissue around the nerve.  Morton’s neuroma affects the ball of your foot, most commonly the area between your third and fourth toes or the second and third toe.

The condition most commonly occurs in middle-aged women and has been linked to wearing high-heeled shoes.  In many cases, people experience relief by switching to lower heeled shoes; however, corticosteroid injections or surgery may be necessary if pain persists.

Symptoms of Morton’s Neuroma

There are generally no visible signs, and in some cases, you may not experience any symptoms at all.  Possible symptoms of Morton’s neuroma include:

• Intermittent pain
• A feeling as though you are standing on a small stone in your shoe
• A burning pain in the ball of your foot and in your toes
• Numbness or a tingling sensation in your toes or foot

Symptoms may worsen when you move your foot or wear tight or high-heeled shoes, and often gets worse over time.  The pain at the ball of the foot may be so severe it causes limping, or prevent you from walking.

Causes of Morton’s Neuroma

Morton’s neuroma is often caused by irritation or pressure.  The condition can cause the nerves in your feet, between the toe bones, to become compressed and irritated.  The affected nerve thickens and becomes increasingly more painful as a result from the pressure on it. Morton’s neuroma is often associated with:

• Foot deformities such as bunions, high arches, hammertoes (misshapen toes) or flatfeet
• Repetitive activities, such as running or tennis that elevate pressure on the ball of the foot
• Activities that involve wearing fitted shoes, such as skiing, rock climbing or ballet
• Wearing tight, pointy or high-heeled shoes

Prevention of Morton’s Neuroma

One of the easiest ways to help prevent Morton’s neuroma is to wear the correct kind of shoes.

• Avoid wearing tight shoes or high heels for extended periods of time
• Choose comfortable shoes that allow your toes plenty of room to wiggle
• Wear socks with extra padding, especially if you stand or walk a lot
• If you take part in sports, make sure you wear footwear that is padded in order to protect your feet

If you see a physiotherapist, you may be given stretches and exercises to help strengthen your legs and ankles.

Diagnosis of Morton’s Neuroma

If you have continuous foot pain that does not go away, even after changing your activities and footwear, you should make an appointment to see your doctor. Morton’s neuroma is treatable, however if it is not treated quickly it can result in permanent nerve damage.

During the diagnosis examination, your doctor will ask you how the pain started, what shoes you wear and what activities you participate in.  Your doctor will carry out a physical examination, pressing on the ball of your foot to feel for a tender spot or see where you experience pain.  Your doctor will generally be able to diagnose Morton’s neuroma from the physical examination; however, to rule out other possible causes of your pain, such as arthritis or a stress fracture, your doctor may order imaging tests.  Some imaging tests are more beneficial than others in the diagnosis of Morton’s neuroma.  These include:

X-rays

Your doctor may order an X-ray of your foot to rule out other potential problems, such as a fracture.

Ultrasound

An ultrasound is very good at identifying soft tissue abnormalities, such as neuromas.

Magnetic resonance imaging (MRI)

MRI scans use radio waves and a strong magnetic field that is very good at recognising soft tissue conditions.

Treatment of Morton’s Neuroma

Treatment depends on the severity of your symptoms.  Your doctor will generally try traditional approaches first and move on to more aggressive treatments if your pain continues.
Certain lifestyle and home remedies can help ease the pain associated with Morton’s neuroma. These include:

• Over-the-counter anti-inflammatory medications, such as ibuprofen can help reduce swelling and ease pain.
• Regularly rolling/massaging with ice may help reduce pain.  Make sure you cover the ice to protect your skin as applying to bare skin cause burns.
• Choose sensible footwear, avoiding high heels or tight shoes.
• Take a break and limit activities such as running, aerobic exercise or dancing for a few weeks.
• Arch supports.  Putting arch supports or footpads in your shoes is usually the beginning of conservative treatment.  Supports will help relieve the pressure on the affected nerve.
• You can buy the inserts over the counter or have them custom made to fit your foot.

If conservative treatments have not helped, your doctor may recommend steroid or anti-inflammatory drug injections into the affected area.  An injection of local anaesthetic can also be used to numb the affected nerve that may help to temporarily ease the pain.

Surgical Options

Decompression surgery

Occasionally, surgeons can release the pressure on the nerve by cutting nearby ligaments and structures.

Removal of the nerve (neurectomy)

If other treatments have failed to relieve the pain, surgical removal of the growth may be required.

Cryogenic surgery

Also known as cryogenic neuroablation or cryotherapy, this technique is carried out using extremely cold temperatures in order to destroy the affected nerves and the myelin sheath covering them.

Post-Operative Recovery

Recovery time will differ depending on the severity of your Morton’s neuroma and the type of treatment you undergo.  Recovery from decompression surgery is generally quite quick and you should be able to weight bear on the affected foot and wear padded shoes immediately after surgery.

Recovery can take longer for a neurectomy, depending on the location of the surgical incision, and can take anywhere from 1 – 6 weeks.  If the cut was made at the bottom of your foot, you may need to use crutches for approximately 3 weeks, resulting in a longer recovery time.  If the incision was made at the top of your foot, you can weight bear on your foot immediately, as long as you are wearing a special boot.

You will have to reduce your activity and sit with your foot raised above your heart level as often as possible and keep the affected foot dry while the incision heals.  Your doctor will change the surgical dressing within 10 – 14 days following surgery, but how soon you can return to work depends on how much time your job requires you to spend on your feet.

Following cryosurgery cryoablation, you will typically experience minimal pain in the recovery phase.  Casts and crutches are not required following the procedure and you can return to daily life after just a couple days of rest and recovery.

Outlook 

The prognosis of Morton’s neuroma greatly depends on the state of the foot when the diagnosis was made.  In some cases, conservative treatments such as injections, changing footwear and rest can cause Morton’s neuroma to completely heal; however, if surgery is performed, the outlook will depend on how much nerve damage exists.  The sooner you receive treatment, the chance of long-term pain relief greatly increases.

In some cases, pain linked to Morton’s neuroma may reoccur despite surgery.  The symptoms can arise due to the end of a nerve being left behind and developing into a neuroma. Follow the preventative steps in order to reduce the risk of recurrence.

Need Help?

At One Healthcare we can book you in to see a specialist Orthopaedic Surgeon for an initial consultation, usually within 48 hours.  Morton’s Neuroma surgery is available at One Ashford Hospital in Kent and One Hatfield Hospital in Hertfordshire. 

You can use your private medical insurance or pay for your Morton’s Neuroma Surgery treatment. We offer competitive, fixed price packages as well as the ability to spread the cost of your treatment over a number of months. If you are using your health insurance, please contact your insurer first for approval and let them know you’d like to be treated at either the One Ashford Hospital or One Hatfield Hospital.

Why One Healthcare

• Modern purpose-built hospital opened in March 2016 (Ashford) December 2017 (Hatfield)
• Fast access to diagnostics including MRI, X-ray and Ultrasound
• Private, spacious, en-suite rooms
• Specialist Physiotherapy and nursing teams
• Little or no waiting time
• ‘Ultra clean air’ theatres
• Freshly prepared food
• Calm, dignified experience

Contact us and find out more

If you live in and around the Kent area and would like to visit our One Ashford Hospital please click here

If you are based in and around Hertfordshire and would like to visit the One Hatfield Hospital please click here.