Performed by – David Hinsley, Ngwe Phyo, Nick Ward

Morton’s neuroma is a swelling of the digital nerve (nerve that supplies sensation to the toes) just before the nerve splits into two to supply the webspace (opposing halves of two adjacent toes). Frequent complaints are of pain on bearing weight under the forefoot, which may be relieved on removing footwear. There may be abnormal sensation (pins and needles or numbness) in the webspace or in the toes, and the sensation of treading on a small marble.

Neuroma are usually suspected after taking a history and a clinical examination. An ultrasound or an MRI scan is usually used to confirm the diagnosis.

Treatment options include avoiding impact activities, altering shoe types, orthotics (insoles) and steroid injections around the nerve. If these fail then the swollen portion of the nerve can be excised.

A Morton’s neuroma can be approached via a dorsal or plantar approach. The dorsal approach divides the deep transverse ligament but may have fewer problems with wound healing and scar-related discomfort. A dorsal longitudinal incision is begun over the centre of the web space (between the MTP joints) and extended approximately 5cm proximally. The neuroma is then removed along with a small section of nerve both proximal and distal to it. This ensures complete removal of the neuroma. The specimen is then sent to the histology laboratory (to confirm diagnosis) and the wound closed with a dissolvable nylon sutures.

Post-operative rehabilitation
Although weight bearing is allowed in the flat post surgical shoe, it is recommended that you keep the foot elevated as frequently as possible during the first few days. Walking long distances should be avoided until wound healing occurs. This is important as it reduces swelling and prevents bleeding into the interspace. The suture ends are removed at 2 weeks and the patient is encouraged to mobilise as comfort allows after this in normal, spacious, flat shoes. Impact activities, such as running, dancing etc should be avoided until at least 6 weeks.

Numbness over adjacent sides of the toes is an inevitable consequence of removing the common digital nerve.