What is it? A Morton's neuroma is a painful condition that occurs when the tissue surrounding one of the nerves leading to your toes thickens. This thickening, often described as a 'swollen nerve', is a benign (non-cancerous) fibrous growth of the common plantar digital nerve. It most frequently develops in the space between the bases of the third and fourth toes, though it can also affect the second and third.

The thickening happens as a reaction to repeated irritation or compression, which causes the nerve to become trapped between the bones of the forefoot (metatarsal bones). This entrapment leads to significant inflammation and, consequently, pain that can severely impact your mobility. It is a common cause of forefoot pain in the UK and is much more prevalent in women.

What are the symptoms? The early symptoms can be vague and might not involve a noticeable lump. Instead, patients often describe sensations like:

• The Pebble: Feeling like there is a small stone, a folded-up sock, or a marble constantly inside your shoe, right under the ball of the foot.
• Burning and Shooting Pain: Sharp, agonizing, burning pain in the ball of the foot, which can radiate outwards to the adjacent toes.
• Tingling and Numbness: "Pins and needles" or numbness in the affected toes.
• Activity-Related Pain: The pain typically worsens significantly when walking, running, or standing, and when wearing tight or narrow shoes. It is often relieved by taking the shoe off and massaging the foot.

What causes it? Anything that compresses or irritates the nerve can contribute to a neuroma:

• Footwear: High-heeled shoes, narrow shoes, or shoes with a pointed toe box are the primary contributors. They squeeze the forefoot bones, directly compressing the nerve.
• Biomechanical Issues: Having flat feet, high arches, or an abnormal walking pattern (like overpronation) can increase the pressure on the forefoot.
• Activities: Engaging in high-impact repetitive sports like running, aerobics, or court sports can increase pressure.
• Foot Deformities: Conditions like bunions or hammer toes can reduce the space between the bones, irritating the nerve.
• Foot Type: People with flexible joints or excessive movement in the metatarsal bones are more prone.

What are the treatment options? If treated early, Morton's neuroma frequently responds well to non-surgical podiatry care. A private podiatrist can provide effective management:

• Metatarsal Dome Padding: (A key treatment) Specialised felt or silicone padding is bespoke-shaped and placed under the foot just behind the neuroma. This subtly spreads the metatarsal bones, taking direct pressure off the compressed nerve and providing significant relief.
• Custom Orthotics: Bespoke insoles designed from a 3D scan of your feet incorporate metatarsal domes and are designed to correct any underlying biomechanical issues, redistributing your body weight more evenly away from the neuroma.
• Footwear Guidance: A crucial part of prevention. We advise on choosing footwear with a wide toe box, low heels, and ample cushioning to eliminate compression and irritation of the nerve.
• Corticosteroid Injections: In cases of severe, debilitating pain and inflammation, we can liaise with your GP for a targeted steroid injection into the affected space to reduce the nerve swelling and provide relief.
• Mobilisation: Gentle hands-on techniques to keep the forefoot joints as mobile as possible.
• Prevention Advice: Guidance on avoiding activities that aggravate the condition.