Morton’s Neuroma is a painful and disabling foot condition affecting the ball of the foot which can be exacerbated from wearing tight, restrictive shoes or high levels of repetitive trauma when exercising. The nerve becomes irritated, enlarged or damaged with pain radiating from its source, normally between the third and fourth toe.
Podiatric Surgeon Mr Stephen Kriss, an expert in foot biomechanics, surgery and managing foot conditions. With 35 years NHS experience, he spoke to us about the condition an insight into the symptoms and potential treatment available.
Walking on a pebble
Morton’s Neuroma is perhaps the most disabling of the many painful foot conditions that I see and treat. It is characterised by an intense burning and radiating pain from the ball of the foot to the lesser toes. The level of pain varies but it has been compared to ‘walking on a pebble’ or likened to a red hot poker being inserted into the foot.
The confounding aspect of the condition is that Morton’s Neuroma gives the patient nothing to see – no swelling, no redness. The pain can be triggered by just a short walk or after walking miles with the toes often numb and burning at the same time. The toes can also buckle or splay as the nerve becomes increasingly swollen, which can distort the adjacent joints and lead to hammering of the toes. The nerve often swells between the 3/4 toes but this can also occur in the 2/3 web space.
Classic symptoms can be reproduced for diagnosis with gentle palpation of the nerve while sometimes there may be multiple trigger points: if pain persists at rest or in bed, this usually indicates that other causes are present and an ultrasound may be needed to confirm the diagnosis.
We have a number of treatment options, depending on symptoms, which could be as simple as switching to wider, flatter shoes, using painkillers and deploying insoles and having foot manipulation. All of these can be effective.
But, more serious and persistent cases could require steroid injection and surgical excision of the nerve, which is performed as a day case surgery.
Please note that currently, steroid injections are contraindicated due to theoretical increased susceptibility to COVID-19 although these regulations are constantly changing.
During lockdown I have spent more time working from home. From my desk I have watched neighbours of all shapes and sizes jogging up and down the road, and can’t help wondering whether they are going to get some musculoskeletal problems associated with this, Morton’s Neuroma being one of them. I hope people keep going with their exercise routine. Despite its risks, I think we all recognise that regular exercise is essential for our mental and physical health, and these past few weeks have confirmed how important this simple pleasure is.
Working in my NHS Trust Intensive Therapy Unit, I’ve noticed that the virus is significantly more prevalent among men than women. A report released by Public Health England recently shows that male sex is a known factor associated with COVID-19-related mortality. Data from the Intensive Care National Audit and Research Centre (ICNARC) has shown that COVID-19 admissions to critical care are mostly among men, making up 71.0% of admissions reported as of 21 May.
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