Morton's neuroma

Entrapment of a nerve at the end of the foot (digitalis plantaris communis nerve) between the heads of the tarsal bone, often caused by node-like thickening of the nerves or a tendon (Ligamentum metatarsale transversum profundum), resulting in pain in the metatarsophalangeal joints radiating to the toes. Morton's neuroma accounts for around 3% of all pain in the midfoot.

Symptoms

Burning, painful altered sensation at the end of the sole of the foot with radiation to the toes, often but not always between the third and fourth toes. In severe cases, patients are barely able to stand up. Pressing on this area makes the symptoms worse. Patients feel the thickening like a pea in their shoe.

Possible causes: frequent injury, foot deformities, inflammations, obesity, tight or high footwear, excessive physical strain, misalignment, sprains, fractures, long-distance running etc.

Treatment

Tarsal tunnel syndrome In mild cases, simply taking pain-relieving or anti-inflammatory medication, the use of injections that include cortisone preparations (painful!), rest and physiotherapy are sufficient to relieve the symptoms of this condition.

If the symptoms last more than 6 weeks, or if the symptoms become unbearable, then surgical decompression is required. The procedure is carried out as an in-patient under general anaesthetics. A small skin incision at the end of the sole of the foot is all that's required to expose the nerve and create more space by dividing the thickened ligament. Success is more likely to be guaranteed by removing the "nerve node".

A protection time of 2-4 weeks is recommended post-operatively. Physiotherapy should then be commenced.