Ep 138 – Morton’s neuroma

Morton’s neuroma is a common condition that results in forefoot pain. It is a condition that can often be diagnosed in primary care and managed with simple changes in footwear and over-the-counter treatments. In this episode, Dr Kate Chesterman discusses the classic presentation of Morton’s neuroma, considers the need for any investigations, and updates us on appropriate self-care advice that can be given to patients.

Key take-home points

• Morton’s neuroma results from compression of an interdigital nerve in the foot and commonly affects the nerve between the third and fourth toes.
• It will usually present with pain in the ball of the foot that can spread to the toes. It may also cause paraesthesia and numbness. Patients commonly describe the feeling of “walking on a marble”.
• It is usually a clinical diagnosis, but investigations can be arranged to rule out differential diagnoses or confirm the diagnosis if there is doubt about the aetiology of the patient’s symptoms.
• Conservative methods such as wearing wide, comfortable shoes with a low heel and soft sole and the use of insoles and metatarsal pads should be tried for 3 months as first-line treatment.
• If this is not successful, then a referral to orthotics should be considered.
• For recalcitrant symptoms, a referral to a foot surgeon for consideration of a corticosteroid injection, radiofrequency ablation or surgery can be undertaken.

Key references

1. Pelly T, et al. BMJ. 2020;371:m3704. doi: 10.1136/bmj.m3704.
2. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/mortons-neuroma.
3. NHS. 2022. https://www.nhs.uk/conditions/mortons-neuroma/.
4. Royal United Hospital Bath. https://www.ruh.nhs.uk/patients/services/clinics/orthopaedic_fracture/documents/Morton%27s_Neuroma.pdf.
5. Patient. 2023. https://patient.info/foot-care/heel-and-foot-pain-plantar-fasciitis/mortons-neuroma.