Morton’s Neuroma

Morton’s neuroma is a painful condition associated with the formation of a benign interdigital neuroma due to repetitive irritation of the nerve.

Common digital nerve to the 3rd or 4th metatarsal spaces is most frequently affected.


Incidence : More common in females, M : F ratio is 8 : 1

Common in women around 15 – 50 years of age


Risk Factors Of Morton’s Neuroma

  • Wearing tight, pointy or high-heeled shoes 
  • Excessive running, walking, squatting
  • Patients with existing foot probvlems 
    • Flat feet
    • High arch
    • Bunions


Pathophysiology Of Morton’s Neuroma


Interdigital nerves transverse at the level of metatarsal heads

                            
During running or walking with heels or pointy shoes
                            
These nerves become compressed or stretched (Irritation) due to repeated toe flexion and extension
                            
Leading to perineural fibrosis and nerve degeneration due to repetitive irritation
(Morton’s Neuroma)




Clinical Presentation Of Morton’s Neuroma

  • Females patient wearing heals / pointy shoes 
  • Shooting, stabbing or burning pain in the forefoot
  • Pain is intermittent 
  • Feels like a stone has stuck under the foot 
  • Passive and active toe dorsiflexion may aggravate symptoms

Investivations Of Morton’s Neuroma

  • Plain X-Ray of foot – Normal
  • Ultrasound scan of foot
    • Can detect the neuroma between the interdigital space
  • MRI can also be used to detect the neuroma


Treatment Of Morton’s Neuroma
  • Rest and elevation of the affected limb
  • Apply ice to the affected area
  • Analgesics – NSAIDs
  • Proper footwear
    • Wear wide, comfortable shoes
    • Avoid heels / point shoes
  • If conservative management fails – Need surgical or non surgical interventions
    • Non surgical interventions
      • Radio frequency ablation
    • Surgical interventions 
      • Decompression surgery
      • Excision of the nerve 
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