Morton’s Neuroma in Perth – Interdigital Neuralgia/Fibrosis

Do you suffer from tingling, burning, or numbness to your toes? A feeling that something is inside the ball of the foot or that there is something in your shoe or your sock is bunched up? Please read on for how we can help you.

Morton’s neuroma is a painful condition that affects the ball of the foot (sole of the foot close to your toes). Morton’s neuroma can also be known as Morton’s metatarsalgia, Intermetatarsal neuroma, and Intermetatarsal space neuroma. Morton’s neuroma is the thickening of one of the nerves leading to the toes. It can cause a sharp, burning pain in the ball of your foot. The toes also may sting, burn or feel numb. It most commonly affects the third and fourth toes but can occur between any two adjoining toes.

Often Morton’s neuroma can occur secondary to other conditions such as hammertoes, metatarsal phalangeal joint instability and long metatarsal bones. It is very important to make correct diagnosis prior to implementing any treatment.

A physical examination of your foot will be performed to see if there is a Mulder’s sign or Mulder’s click. This test has 96% sensitivity and 96% accuracy in diagnosing neuromas (Mahadevan 2015). It is performed by compressing the forefoot to produce pain and palpable click in the forefoot using the thumb index finger squeeze test (along with deep palpation of the thumb in the affected interspace). We can also refer you for an ultrasound scan to confirm our diagnosis and the exact size of the neuroma. The size of the neuroma can determine the success of conservative therapy. MRI may be necessary in cases where the neuroma pain cannot be differentiated from any other causes of forefoot pain such as plantar plate pathology (metatarsal phalangeal joint instability).

We highly recommend you see one of our podiatrists who can offer you all the conservative treatment options for Morton’s neuroma. Morton’s neuroma treatment in Perth at Foot Focus Podiatry include:

Padding – metatarsal dome (sometimes known as met domes); deflective / shaft padding
Orthotics – to help alleviate the area
Physical therapy – hands on therapy to restore proper motion and mobility as well as home stretching and strength exercises.
Activity modification – education how to perform specific tasks or exercise regimes in a better way and shoe modifications.
Icing and anti-inflammatories

Should our conservative Morton’s neuroma treatment not be successful then Dr Reza Naraghi (the podiatric surgeon who attends the rooms at Foot Focus Podiatry) and is able to prescribe and administer non-steroid anti-inflammatory medications and injection therapy. A cortisone injection aims to shrink the bursal component of the neuroma/bursal complex therefore reducing the irritation of the nerve.

Additional treatments for Morton’s neuroma include radiofrequency ablation and ultrasound-guided alcohol injection. These options can be considered before surgical intervention. Our podiatrists can arrange a referral to one of Perth’s radiology clinics for these services. Any chosen method is more effective when combined with conservative therapies such as padding, orthotics, hands-on therapy, and shoe modifications.

We are privileged to have Dr Naraghi attend our rooms twice a week. Reza is right up to speed with the latest research on Morton’s Neuroma having completed his PhD studies on the aetiology (causes) and epidemiology of Morton’s neuroma from UWA in 2018. He has expertise in the conservative and surgical management of Morton’s neuroma and can discuss the best approach for management of your Morton’s neuroma.

Morton’s Neuroma surgery in Perth may be considered for patients who have not responded adequately to conservative treatments. Dr Reza Naraghi (podiatric foot surgeon) will determine the approach that is best for your condition. Depending on the procedure performed, recovery periods vary. In most cases patients can wear normal shoes in 10-14 days. The following are the common surgical procedures performed for Morton’s neuroma.

Neurolysis

This procedure involves making an incision (minimal) on the affected interspace. The deep transverse metatarsal ligament will be released, and the nerve is freed from any scar tissue entrapping it. The recovery period for this procedure is quick and you will be in post-operative shoe for one to two weeks. Following removal of the sutures you may progress to any shoe.

Neurectomy (incision on top of the foot)

This procedure removes the affected nerve in the interspace by making an incision on top of the foot. The affected nerve is removed as far back as possible to prevent recurrence or stump neuroma formation. You need to keep your bandage clean and dry for 2 weeks. You may walk immediately after the procedure with a post-operative shoe. The sutures are removed after 2 weeks and you can progress to regular athletic type footwear. For some of you that may be interested in the surgical procedure please click here to see further photos.

Neurectomy (incision on the bottom of the foot)

Making the incision on the bottom of the foot is reserved for Morton’s neuromas that can reoccur as a result of stump formation. It is easier to get to the nerve using this approach; however, the patient may need to be off their foot for 2-3 weeks to prevent scar formation. You can’t get your foot wet for minimum 2 weeks and you can progress to athletic type footwear after 3 weeks. For some of you that may be interested in the surgical procedure please click here to see further photos.

With all procedures you may be required to get hands on podiatry work and myofascial therapy which is all provided at Foot Focus Podiatry.

Please see below the list of articles by Dr Reza Naraghi on Morton’s neuroma. Dr Naraghi’s work on Morton’s neuroma has been referenced internationally in the high calibre journals and recently in the book “Pathomechanics of Common Foot Disorders” by Dr Richie.

Journal articles on Morton’s Neuroma written by our surgeon Reza Naraghi (PhD)

The epidemiology and aetiology of Morton’s neuroma

Calf tightness linked to Intermetatarsal Neuroma

Morton’s Neuroma – x ray findings