MORTONS
This is an inflammation and thickening of a nerve in the foot,
found between the metatarsals. It is thought to result from
repetitive trauma or friction from tight shoes. It can be mistaken
for metatarsalgia.
Symptoms
Common symptoms include pain in the ball of the foot associated with burning and/or pins and needles in the toes. Sometimes there is numbness in the toes.
Non-operative management
Measures to off load this painful area, such as metatarsal pads and modification of foot wear, can help alleviate symptoms.
If an ultrasound scan is being requested to investigate the diagnosis, there is an opportunity to do a guided injection at the same time if a neuroma is present. This is usually a corticosteroid injection, which if effective can help to reduce inflammation.
Surgical management
If non-operative measures fail to resolve symptoms, the surgical option would be excision of the neuroma through an incision on the top of the foot. With excision of the nerve, the webspace and side of toes will remain numb but will not be painful.
Risks of Surgery
As with any surgery there are potential risks. This will be discussed in more detail during the consultation, however common complications are stiffness, swelling, nerve injury, infection, and recurrence of symptoms from a stump neuroma.
Recovery
Your foot will be in bandaging and a surgical shoe will be provided to allow you to weight-bear whilst protecting the foot. You will be provided with crutches for support. Elevation, as much as possible, is important in the first few weeks. The bandaging will come down at 2 weeks and dressings changed, and at this stage I would allow the foot to go into a normal comfortable shoe. Swelling can be expected to be present for up to 6 months, particularly in the evenings.
With regards to return to work, it is dependent on the amount of weightbearing required. If the work is sedentary and you can keep the foot elevated, then return after 2 weeks is satisfactory. Otherwise, return to work should be expected after 4 weeks.