Morton’s Neuroma

Morton’s Neuroma is a frequently observed foot deformity and affects the third interspace more commonly than the second or fourth spaces. Morton’s Neuroma involves changes consistent with fibrosis of the proper digital nerves. The condition is commonly referred to as a Neuroma although this is misleading as it reflects more of a swelling/fibrosis of the nerve rather than a true Neuroma.

 

 

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Causes

Causative factors of Morton’s neuroma include biomechanical anomalies such as ill-fitting footwear, collapsed arches and genetic predisposition.

Diagnosis

A positive ‘Mulder’s’ Click can indicate the presence of Morton’s Neuroma although both specificity and sensitivity are poorly researched. Ultrasound and MRI provide good predictability although usually a diagnosis is made purely on clinical judgement alone. Differential Diagnosis includes: Plantar plate rupture of the lesser metatarsals, lesser metatarsal capsulitis, peripheral neuropathy, peripheral symptoms associated with sciatica, neuritis/localised digital nerve entrapment.

Conservative Management

  • Padding: Padding provides support for the metatarsal arch to reduce the pressure on the nerve and decreasing the compression force on weight-bearing activities
  • Icing helps reduce swelling.
  • Orthotics: Custom orthotics aim to reduce pressure and compression on the nerve if faulty foot biomechanics are present
  • Activity modifications: Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
  • Footwear modifications: Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels
  • Injection therapy: Treatment may include injections of cortisone, local anaesthetics or other agents.

Surgical Management

In order to eliminate pain associated with a benign thickening of a nerve between two toes, resection of the thickened nerve is sometimes necessary. Surgery involves a longitudinal incision (3cm) on top of the foot between metatarsal bones and identifies and remove the neuroma. Neurectomy can be performed under anaesthetics(General or Local) and around 75% of patients are happy with the outcome of the procedure and become pain-free.

Frequently asked questions about neurectomy for Morton’s neuroma. 

When can I walk?

  • 0-3 weeks: Full weight bearing in the postoperative surgical shoe
  • >3 weeks: Full weight bearing in soft comfortable shoes

Can I get my foot wet in the shower?

In the first 2 weeks, keep the foot dry. You may shower with a waterproof cover over your foot.

How can I look after the incision wound?

Do not pull at scabs but let them fall away naturally. If your wound becomes red, swollen or sore, you need to see your surgeon.

When can I start to drive?

Do not drive until you are confident about controlling your vehicle and always check with your doctor and insurance company. Generally, it will take 4-6 weeks.

When can I work again?

  • Sedentary jobs: 1 week
  • More active employment: 2-3 weeks

When can I return to exercises or sports?

It varies depending on individuals’ healing but it usually takes 1 month before weight-bearing exercises and slightly earlier for semi or non-weight bearing exercises such as swimming or bicycling.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner

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