A neuroma is a thickening of a nerve, usually because of long-term mechanical irritation. They can occur in many locations in the body, but when they occur in the ball of the foot, they are called Morton’s Neuroma. The most common location is between the third and fourth toes and, less commonly, between the 2^nd and 3^rd toes. Squeezing across the ball of the foot will aggravate the nerve. Symptoms can range from intermittent pain, cramping, or burning in the ball of your foot to numbness affecting the toes. Relief may be obtained temporarily by removing shoes and massaging the foot. On some occasions, there can be inflammation of the joints in the ball of the foot, which is hard to differentiate from neuroma pain.

Several conditions can cause neuromas, but they are usually related to situations that compress the front of the foot and damage the nerve. Tight shoes, arthritis, work or recreational activity, foot deformity (e.g., bunions), and trauma can lead to the development of a neuroma.

Diagnosis of the condition is primarily based on the patient’s symptoms and description of the pain. Many times, a movable mass can be felt in the space behind and between the toes, and if compressed, it will cause a clicking sensation and sometimes pain. Diagnostic ultrasound can identify other potential causes of pain in the ball of the foot, such as intermetatarsal bursitis, plantar plate tears, and joint inflammation.   MRI is also sometimes used, but neither ultrasound nor MRI is 100% reliable in the diagnosis of neuroma, and findings need to be correlated with clinical symptoms

Pain when walking steadily worsens toward the end of the day. In cases where the condition progresses to the extent that there is a partial tear or rupture of the tendon, this will lead to a pronounced flatfoot deformity. At this stage, the spring ligament deep in the foot’s arch is also often involved.

Once neuromas have formed, they do not go away, but things can be done to relieve the irritation to the neuroma, which causes pain. Treatment generally involves modifying or changing shoes and metatarsal pads to separate the bones in the area so they don’t press on the nerve. Orthoses can also be used.

Cortisone infiltration around the nerve, mainly if a bursa is present, can be very helpful, but sometimes only for a limited time. Injections can be repeated, but if they are used too often or in the wrong area, the fatty tissue in the ball of the foot can atrophy, adding to the discomfort.

Once neuromas have formed, they do not go away, but things can be done to relieve the irritation to the neuroma, which causes pain. Treatment generally involves modifying or changing shoes and metatarsal pads to separate the bones in the area so they don’t press on the nerve. Orthoses can also be used.

Cortisone infiltration around the nerve, mainly if a bursa is present, can be very helpful, but sometimes only for a limited time. Injections can be repeated, but if they are used too often or in the wrong area, the fatty tissue in the ball of the foot can atrophy, adding to the discomfort.

In many cases, conservative treatment can eliminate almost all pain associated with a neuroma; however, as the damage and thickening of the nerve are permanent unless conservative treatment is followed, the pain will most likely return.

A differential diagnosis for other causes of pain in this area is Tarsal tunnel syndrome. The nerve that passes through the same location as the tendon can become irritated, leading to burning, shooting, tingling, or stabbing pain.

Not treating the problem and allowing the condition to worsen and the arch to collapse will affect a person’s ability to run and walk, leading to arthritis, severe foot pain, and straining of other joints in the leg.

In some situations, the nerve is damaged and thickened to a point where conservative treatment does not help, so surgery is the best option if the pain is ongoing.

Surgery involves excision of the thickened section of the nerve. This can be done on a day surgery basis under a twilight anaesthetic. Activity is limited for about 2-3- weeks. There is some residual discomfort in the ball of the foot, which can last up to 3 months. There is a small area of reduced sensation between the two toes, which is permanent. Overall, surgery for neuromas is very successful, with low rates of complications.

Radiofrequency ablation can be used to destroy the nerve, which is a minimally invasive procedure that is performed under anesthesia but has variable rates of success. Alcohol injections into the neuroma to cause nerve sclerosis have also been used but have had limited success.

In cases that have been neglected, and a painful flatfoot deformity is present, a fusion (arthrodesis) of one or more joints in the foot to correct the position of the foot may be necessary. A fusion is an operation where a joint between two bones is removed, and the two bones on either side of the joint can grow together – or fuse. This type of operation is generally used to stop pain from joints that are worn out. Usually, several joints must be fused to control the flatfoot deformity occurring after posterior tibial tendon rupture.