Morton’s neuroma refers to a painful irritation or thickening of the nerves that extend from below the metatarsal bones to the toes. The most common cause is an overload in this area due to inadequate weight distribution on the first metatarsal bone (Hallux valgus). Characteristic symptoms of Morton’s neuroma include “pulling,” electrifying discomfort, particularly when wearing tight shoes.

The diagnosis is primarily clinical and determined through an examination, often using the Mulder test. Further investigations, such as an MRI, may follow but are often not strictly necessary. If relieving insoles are not effective and/or the underlying cause cannot be addressed (e.g., through Hallux valgus surgery), an attempt can be made to inject a cortisone preparation at the affected site. If this provides significant or partial relief, the injection may be repeated 1-2 times. If this is not effective or not sustained, nerve surgery may be considered.

There are two surgical methods for Morton’s neuroma:

1. Neurolysis:
The nerve is “freed” similarly to carpal tunnel syndrome, meaning it remains in place.

2. Excision:
The thickened nerve is surgically removed. This procedure is associated with a slight decrease in sensation in the toes it supplies, but this is typically not noticeable in everyday activities.

Since both surgical methods have their pros and cons, and the success rate for both is only about 85%, the choice between them is often made during the surgery at ARS PEDIS based on individual considerations.