The digital nerve(1) running in the narrow space between the metatarsal bones where it splits into two(2) and where a Mortons Neuroma is usually found.
A swollen digital nerve(1), with large Mortons Neuroma(2) present at the point of splitting into two individual nerves(3).
What is a Mortons Neuroma?
A Neuroma is a swelling occurring in the substance of a nerve.
If this is a nerve problem should I expect problems with moving the toe?
No, at the level of the foot at which the Mortons Neuroma occurs only sensation is affected if the nerve malfunctions.
Why does a Mortons neuroma occur?
The nerve runs in a narrow space between the metatarsal heads and is liable to recurrent compression here. The nerve responds by becoming chronically swollen. It therefore has even less space in which to sit and is more liable to further compression and irritation.
What symptoms might I have with a Mortons neuroma?
The main type of symptoms a patient may have with a Mortons neuroma is one of pain. This is usually present just on weight bearing activity (standing or walking). The pain tends to be felt at the base of the toes
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and often, but not always, radiates down into the toes with a tingling sensation. It is important to remember that a Mortons neuroma is only one cause of pain in the forefoot.
How is a Mortons neuroma diagnosed?
A diagnosis is initially by examination, and finding specific tenderness in one of the webspaces, which is then confirmed by ultrasound scanning.
What treatments are available?
Whether treatment is required, or not, this is determined by how troublesome the Mortons neuroma condition is.
Non Operative Treatment
Orthotic The whole front of the foot can be off-loaded by an orthotic insole, worn in the shoe.
Injection - The relevant webspace, which contains the Mortons neuroma can be injected with steroid and local anaesthetic.
What if non operative treatment fails?
A Mortons neuroma can be excised surgically as a day case procedure.
How likely is surgery to be curative
85% much improved and 65% entirely pain free.
Can symptoms come back after complete resolution?
Yes, very rarely the condition can reoccur from residual nerve tissue after initial adequate excision of the
Mortons neuroma
Surgical excision of a Mortons neuroma - Primary case
(images from several cases)
The incision, between the two affected toes into the web space.
The incision deepened between the The mortons neuroma (1) metatarsals to reveal the neuroma(1).
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The nerve at the point of branching(2) where the neuroma occurs.
The neuroma being dissected free. The proximal end of the nerve(1), now divided, the neuroma(2) and the two digital nerves(3) into which it splits.
The neuroma excised. The wound closed with absorbable suture
The compressive dressing to be worn for 2 weeks post operatively.
The first 24 hours
Pain relief
This is by means of a regional intermetatarsal nerve blockade supplemented by pain relieving tablets.
Dressings
A heavy bandage(as above) is to be worn for two weeks.
Length of stay
Day case.
At two weeks
An outpatient visit is scheduled to ensure wounds have healed, bandages are removed and histology confirmed of the removed nerve.
The patient will now be able to return to a normal shoewear and activities.
Results
Loss of all pain-65%
Loss of all pain or much improved-85%
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Patients are to expect numbness, from complete to incomplete, affecting the neighbouring toes supplied by the swollen digital nerve, which has been removed. There should be no long term effect upon movement of the toes after removing the nerve.
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