Pain on the ball of the foot is very common and there are many causes.
What is a Mortons neuroma?
Mortons neuroma is an irritation and swelling of the nerve which runs between the metatarsals. It is commonest between the 3rd and 4th toes but also occurs between the 2nd and 3rd toes.
What is Intermetatarsal bursitis?
This is inflammation of a small fluid filled sac that lies between the metatarsal heads.
The bursa becomes swollen and can cause pressure on the nerve in the web space.
What are the symptoms?
Symptoms for both Mortons neuroma and intermetatarsal bursitis are similar.
Patients report pain on the sole of the foot as if they are walking on a pebble.
They may experience a burning sensation and become aware of reduced sensation in the web space between the toes.
Symptoms are worse with walking and in narrow shoes.
What is the non surgical treatment?
Treatment for both conditions is similar.
- Pain relief
- Activity modification
- Wearing wider shoes with less heel
- Metatarsal dome insert which opens up the space between the metatarsals and reduces symptoms
- Steroid injection – this can provide long term relief in approximately 50% of patients. This can be repeated
- Radiofrequency ablation- this is performed by a radiologist.
What is the surgical treatment?
Surgery is reserved for when symptoms have not responded to non surgical treatment.
Surgery involves an incision on the top of the foot in the webspace.
In intermetatarsal bursitis the bursa +/- nerve is resected.
In a Mortons neuroma the nerve is removed. This causes permanent numbness in the web space and down the side of the toes.
What does the rehabilitation involve?
- This is day surgery
- For the first 2 weeks you should keep your foot elevated as much as possible to minimize swelling
- You can begin weightbearing immediately in a post operative shoe. This shoe is to be worn for 2-4 weeks
- By 6 weeks you will be back to most daily activities
- 3 months for final result and a return to wearing normal shoes
How long will I be off work?
This is dependent upon your occupation:
- Seated job 2-3 weeks
- Standing job 4-6 weeks
- Heavy lifting job 8-12 weeks
When can I drive?
If you have a manual car you will be unable to drive whilst in the post op shoe.
If you have an automatic car you can drive after 2 weeks if you have your left foot corrected.
If you have your right foot corrected you are unable to drive until you are out of the post op shoe.
What are the risks of the procedure?
General risks of surgery
- Infection and wound healing problems
- Scar sensitivity
- Blood clots to the leg
- Anaesthetic problems
- Incomplete resolution of symptoms
Specific risks for Mortons neuroma surgery
- Numbness in the web space in all cases
- Recurrence of neuroma
- 20% risk of no improvement
- Small risk of being made worse