Mortons neuroma is when the nerve between toes two and three or toes three and four becomes thickened and inflamed. This can occur at any age but is rarely seen in people under 25 years of age. Neuromas are much more common in women which suggests footwear plays a role in the development of this condition. Most people experience a burning pain that can radiate into the toes but only about 20% experience actual numbness. Neuromas are more common in the presence of toe deformity such as bunions and hammer toes.
This involves orthotic insoles, footwear advice and injection therapy. Of these three treatments injection therapy of corticosteroid is the most successful (link to injection therapy).
Unfortunately experience suggests that conservative treatment is often not successful and half of patients are likely to require surgery. Surgery involves removing the inflamed thickened nerve. This reduces the sensation to the side of the two affected toes. Some people will regain sensation to this area over time.
Neuroma surgery is generally successful although in the literature the success of surgery is variable.
Can neuromas come back?
Unfortunately yes. Although conservative care can resolve the pain from a neuroma, with time symptoms can recur. In this situation conservative care usually through injections can be performed but if pain persists then surgery would be recommended in most cases.
Following surgery neuromas can recur and this is usually termed a stump neuroma. The frequency of this is unknown but experience suggests about 1 in 10 will recur. Conservative care can be performed again through insoles, injections and also physiotherapy to help with scar tissue. Probably about 50% of stump neuromas require further surgery (5% of all neuromas). Often stump neuroma surgery is less successful than primary neuroma surgery.
Are there alternative treatments to surgery?
If conservative care fails then surgery would normally be recommended and this remains the gold standard treatment. Other treatments including alcohol injections (sclerotherapy) and freezing (cryotherapy) have been recommended as an alternative to surgery. However for alcohol injections results are not as good as surgical excision and for cryotherapy there are no currently no published research studies on its use. Anecdotally Mr Yates has seen many patients where these treatments have failed and patients then need to undergo standard surgical excision.