MORTON'S NEUROMA 

What is Morton’s Neuroma?
A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton’s neuroma, which occurs between the third and fourth metatarsal bones, at the base of your toes. Neuromas may also occur in other locations in the foot.
The thickening of the nerve is the result of compression and irritation, and this causes pain.
It is rare for more than one nerve to be affected, and it usually only affects one foot.

Causes
Anything that causes compression or irritation of the nerve can lead to the development of a neuroma.
 One of the most common offenders is wearing shoes that have a tapered toe box or high-heeled shoes that cause the toes to be forced into the toe box.
 People with certain foot deformities—bunions, hammertoes, flatfeet or more flexible feet—are at higher risk for developing a neuroma.
 Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or court sports.
 An injury or other type of trauma to the area may also lead to a neuroma.

Symptoms

If you have a Morton’s neuroma, you may have one or more of these symptoms where the nerve damage is occurring:
•    Tingling, burning or numbness
•    Pain
•    A feeling that something is inside the ball of the foot
•    A feeling that there is something in the shoe or a sock is bunched up
 
The progression of a Morton’s neuroma often follows this pattern:
•    The symptoms begin gradually. At first, they occur only occasionally when wearing narrow-toed shoes or performing certain aggravating activities.
•    The symptoms may go away temporarily by removing the shoe, massaging the foot or avoiding aggravating shoes or activities.
•    Over time, the symptoms progressively worsen and may persist for several days or weeks.
•    The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.
 
Treatments
The sooner you seek help and start treatment the better, as the condition can become very painful if ignored.

You can try these treatments yourself:
•    Rest and raise your foot when you can
•    Hold an ice pack (or bag of frozen peas) in a towel on the painful area for up to 20 minutes every few hours
•    Gently massage the painful area
•    Take ibuprofen or paracetamol
•    Wear wide, comfortable shoes with a low heel and soft sole
•    Do not wear high heels or tight, pointy shoes
•    Use soft insoles or pads you put in your shoes
•    Try to lose weight if you're overweight
•    Reduce/modify or abstain from activities that aggravate the condition
If these do not help, you should seek professional help.

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Your podiatrist may recommend insoles or orthotics which reduce stress on the forefoot and include specific support for the anterior metatarsal arch. Orthotics also assist in distributing your weight more evenly over the entire foot, relieving the pressure on the ball of the foot.

If orthotics do not help it may be necessary to speak to your GP about further options, such as:
•    Steroid or local anaesthetic injections, or a combination of both
•    Surgery to remove part of the damaged nerve tissue
•    Freezing (cryotherapy) is sometimes used but is not widely available in the UK.
•    Radiofrequency ablation is another treatment which has been studied. This involves treating the nerve with heat energy waves. It is not yet proven how effective this is.

What is the outlook?

About one third of people with Morton's neuroma get better just with changing their footwear and using metatarsal pads and/or orthotics.
Of those who choose to have surgery, about three out of four will have good results with relief of their symptoms.

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