Understanding Morton's Neuroma: A Comprehensive Guide

A Specific Form of Metatarsalgia

Medicine is a curious field. Many findings are accidental, names can be confusing, and it often takes decades to refine the truth behind initial observations. Take, for example, the pain that Civini, Durlacher, and Morton discovered before the 20th century.

Thomas George Morton claimed the prize for this discovery. His name stuck because he was a published surgeon in a medical journal. His observations were also more open than those of Durlacher.

PDN = plantar digital neuroma is a more accurate term than Morton's nerve pain.

The squeeze test across the metatarsals (shaded) can be performed at home. Taken from my latest book. Podiatrist Turned Patient.

Hoadley (1893) removed the nerve, while Morton cut out the bone! The incidence of Morton's neuroma is estimated at 88 per 100,000 in females and 50 per 100,000 in males, according to data from a large database by Latinovic (2006). Morton's neuroma, also known as a plantar digital neuroma (PDN), is more common than Durlacher’s second-third toe neuroma.

Podiatrist Turned Patient

I first wrote about my own experience and surgical journey in 2017. Since then, I have lectured nationally at various meetings. My book includes my personal journey through surgery and recovery.

The second edition is now available in hardback, paperback and eBook.

What is Morton's Neuroma? How Do We Diagnose This Condition?

Morton's neuroma involves a small nerve (MN) trapped between the metatarsal bones. This entrapment sends electric shock and pain signals into the toes. It can affect one foot, both feet, or multiple sets of toes. The squeeze test is about 41% sensitive in determining the presence of a neuroma, but ultrasound is the primary method for checking.

An ultrasound is between 95-99% sensitive and an important diagnostic tool, but can be confused with a bursa.

What We Now Know

Nerves can recover, but they often start to malfunction due to local inflammation. Symptoms of what we call neuritis can shoot back up the foot. These symptoms are usually short-lived and occur when the foot is compressed. Most people seek help between the ages of 40 and 60. However, some experience this condition as early as 20-30 years old. If caught young, recovery can be promising.

In 1995, Gordon Bennett studied 115 patients over two years. He found that thirty-nine per cent improved with insoles and footwear alterations. In other words, they changed their shoes. Baransel Saygi (2019) discovered that adding a steroid to the use of insoles increased the benefit from 11% to 82% over one year. This works only if the shoes used to accommodate orthoses are better than the shoes previously worn.

Steroid Injections

Steroid injections have been widely used. More has been written about the follow-up of large patient groups than any other form of injection. Overall improvement can be less than 50%. Most follow-ups have not exceeded the two-year mark. In a 2017 study by Grice, immediate results shot up to 87%, but then dropped to 31% at two years.

Alternative Methods of Treating PDN

There are several alternative methods for treating PDN:

• Radiofrequency treatment under local anaesthetics has gained popularity. Even the government agency NICE has cautiously approved this treatment.

• Cryotherapy (freezing) appears to have a place, with results and risks comparable to surgery.

• Capsaicin (chilli powder) has been used, but the study was too small to draw firm conclusions. Hyaluronic acid (think glucosamine) has also been explored.

• Alcohol injections have gained more research recently. This is usually diluted and takes the form of ethanol or phenol.

  
  

You might notice that pain medicines haven't been discussed much. This is because they are more the domain of the GP, who, forgive my cynicism, often uses pain medicine for feet as a temporary solution. Sadly, this approach is outdated and contributes to the issues seen in the UK's collapsing NHS system due to long waiting times.

Many conditions require earlier tests (imaging) and treatment to prevent deterioration. Without early intervention, conditions like neuroma become less manageable and may require surgery, which, as DiCaprio points out, is, at best, 85% successful.

What’s the Final Advice for Morton's Nerve Pain (PDN)?

• Try self-help treatments first. If pain persists or worsens, seek professional advice.

• Avoid multiple steroid injections, as their benefits are often short-lived.

• If you're considering surgery, download the FREE neuroma factsheet HERE.

  
  

My books on neuroma provide guidance, self-diagnosis tools, and insights into the best treatment options. You can still purchase the 2017 edition for £3.99. The new Autumn version will include more material and expand on this article. It will be available in three formats, including a hardback cover in colour.

If you see a UK GP, ask for a referral to a foot specialist. This is someone qualified and trained in orthopaedics or podiatric medicine. In the UK, all podiatrists are licensed to practice through a government-recognised register called the Health and Care Professions Council.

VIDEO TALKS & BOOKS

In February I published a series of three talks on different aspects of Morton's neuroma. Download them from this site under videos or from this YouTube link.

David has also written extensively about bunion problems, self-help and advice about surgery.

David is a former podiatric foot surgeon with over thirty years of experience.

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