Mortons neuroma is a common and often painful condition affecting the ball of the foot, typically between the third and fourth toes. It’s not a true tumour, but rather a thickening of the nerve tissue, often due to irritation, compression, and inflammation. This can lead to a burning pain, numbness, tingling, or the sensation of “walking on a pebble.”
If you’re experiencing these symptoms, seeking a proper diagnosis and effective treatment is crucial to prevent the condition from worsening and potentially causing permanent nerve damage.
Diagnosis of Mortons Neuroma
Before embarking on any Morton neuroma treatment, an accurate diagnosis is essential. Your doctor will likely begin with a clinical examination of your foot. This may involve:
Palpation
Applying pressure between the toes to pinpoint the exact location of pain.
Mulder’s Click Test
Squeezing the forefoot from side to side can sometimes reproduce a painful click or sensation.
Web Space Tenderness Test
Directly pressing on the web space to elicit pain.
While clinical diagnosis can be highly accurate, imaging techniques are often used to confirm the presence of a neuroma and rule out other conditions.
Ultrasound
This is a highly effective and cost-efficient imaging modality for visualising soft tissue abnormalities like neuromas. It can show a thickening of the interdigital nerve greater than 3mm and identify coexisting issues like bursitis. Importantly, ultrasound provides precise guidance for targeted Morton neuroma injections.
MRI (Magnetic Resonance Imaging)
MRI offers excellent soft tissue contrast and can detect neuromas, though it’s typically more expensive. It can be useful in complex cases or to rule out other pathologies.
Diagnostic Local Anaesthetic Injection
Considered the “gold standard” for diagnosis, injecting a local anaesthetic around the suspected nerve can confirm Mortons neuroma if it significantly alleviates the pain. This diagnostic step can also predict the success of certain injection-based Morton neuroma treatment options.
It’s worth noting that imaging can sometimes show neuromas in people without symptoms, so findings must always be correlated with your clinical presentation.
Non-Surgical Morton Neuroma Treatment
For most individuals with Mortons neuroma, non-surgical approaches are the initial and often successful treatment. These conservative measures aim to reduce inflammation, alleviate pressure on the nerve, and improve foot mechanics.
1. Footwear Modifications and Orthotics
This is often the simplest yet most impactful Morton neuroma treatment.
Wider Shoes
Opt for shoes with a wide, deep toe box to prevent compression of the forefoot and toes. It’s also important to avoid high heels and shoes with narrow-toe boxes.
Low Heels
Lower heels distribute pressure more evenly across the foot, reducing strain on the ball of the foot.
Padded Insoles
Shoes with cushioned insoles or over-the-counter shoe pads, especially metatarsal pads placed behind the ball of the foot, can provide cushioning and redistribute pressure away from the affected nerve.
Orthotic Devices
Custom-made or over-the-counter orthotics can support your feet and improve foot biomechanics, reducing pressure on the neuroma.
2. Medications and Self-Care
Effectively managing your health involves a combination of prescribed medications and proactive self-care practices. Understanding both aspects is crucial for recovery and long-term well-being.
NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)
To alleviate pain and inflammation, you can try over-the-counter medications such as ibuprofen or naproxen. However, they are generally considered short-term solutions.
Ice Massage
Applying ice or cold packs to the affected area can help alleviate pain and reduce inflammation.
Rest and Activity Modification
Reducing high-impact activities like running or jumping can give the nerve time to heal.
3. Injection Therapies
When conservative measures aren’t enough, injections are a common next step in Morton neuroma treatment. Many of these are now performed with ultrasound guidance for increased accuracy.
Corticosteroid Injections
These injections deliver potent anti-inflammatory medication directly to the nerve, reducing swelling and providing significant pain relief for weeks or months. While effective for early to moderate cases, repeated injections should be monitored due to potential tissue damage.
Sclerosing Alcohol Injections
This technique involves injecting a small amount of alcohol around the nerve to reduce the thickened tissue. Success rates vary, but some studies report long-term relief.
Radiofrequency Ablation (RFA)
RFA uses a high-frequency electrical current to generate heat, which disrupts nerve conduction and reduces pain. This minimally invasive procedure has shown high success rates, with some studies reporting 88% patient satisfaction.[1]
Cryogenic Neuroablation (Cryoablation)
Similar to RFA, cryoablation uses extreme cold to destroy targeted nerve cells, reducing inflammation and pain. It’s a precise method that can provide long-lasting relief, often with minimal side effects like loss of motor function.
4. Physical Therapy
Physiotherapy addresses the root biomechanical causes that contribute to Morton neuroma, making it an essential component of effective treatment. This may include:
Foot Exercises
Strengthening intrinsic foot muscles to improve arch support and reduce pressure on the nerve.
Stretching
The calf muscle and plantar fascia stretch can alleviate tension and reduce nerve compression.
Manual Therapy
Techniques like massage and soft tissue mobilisation can help release tight structures and reduce nerve irritation.
Surgical Morton Neuroma Treatment
While many cases of Mortons neuroma respond well to non-surgical treatment, surgery may be considered if conservative measures fail to provide lasting relief or if the pain is severe and debilitating. It’s generally reserved as a last resort.
The most common surgical procedures include:
Neurectomy
Neurectomy involves surgically removing the affected portion of the nerve. It is typically regarded as the most conclusive surgical approach for treating Mortons neuroma, with success rates documented between 82% and 93%.[2] However, it can result in permanent numbness in the affected toes.
Nerve Decompression
In some cases, pressure on the nerve can be relieved by cutting nearby structures, such as the ligament that binds the metatarsal bones together.
It’s important to be aware that even after successful surgery, there’s a possibility of recurrence (5-20% of cases), though repeat surgery often has a similar success rate. Complications can include painful scar formation, stump neuroma (re-growth of the nerve), and infection. Recovery time for surgical procedures can also be longer than for minimally invasive injections.
A Holistic Approach to Morton Neuroma Treatment
Effectively managing Mortons neuroma often calls for a varied approach. Starting with simple self-care and footwear changes, progressing to injections if needed, and considering surgery only when other options have been exhausted. This layered approach allows for a customised Morton neuroma treatment plan.
If you suspect you have Mortons neuroma, consult with a healthcare professional, such as a podiatrist or orthopaedic surgeon, for an accurate diagnosis and a personalised Morton neuroma treatment strategy. Early intervention can significantly improve outcomes and help you return to pain-free activity.
Step Into Relief With Expert Morton Neuroma Care
Sydney Podiatry specialises in diagnosing and treating Mortons neuroma using the latest, evidence-based techniques. From custom orthotics and guided injections to advanced non-surgical therapies, our goal is to help you walk pain-free, without rushing to surgery unless absolutely necessary. Our experienced podiatrists will tailor a Morton neuroma treatment plan that suits your lifestyle and ensures long-term relief.
Contact Sydney Podiatry now to book your personalised consultation and get back on your feet faster.
