Mortons neuroma & Inter-metatarsal bursitis

Pain on the ball of the foot is very common and there are many causes. Amongst the most common are the two discussed below (Mortons neuroma & Intermetatarsal bursitis). These are discussed together because both can appear together and have similar symptoms & treatments.

What is a Mortons neuroma?

Mortons neuroma is an irritation and swelling/lump of the nerve which runs between the end of the metatarsal bones. It is most common between the 3rd and 4th toes but also occurs between the 2nd and 3rd toes.

What is Inter-metatarsal bursitis?

This is inflammation of a small fluid filled sac that lies between the metatarsal heads.
The bursa becomes swollen and can cause pressure on the nerve in the web space. Like Mortons neuroma it is also most common between the 3rd and 4th toes.

Mortons_Neuroma_1 Mortons_Neuroma_2

Pain occurs more commonly
focused in-between the
3rd & 4th knuckles


What are the symptoms?

Symptoms for both Mortons neuroma and Inter-metatarsal bursitis are similar.
Patients report pain on the sole of the foot as if they are walking on a pebble.
They may experience a burning
or gnawing sensation and become aware of reduced sensation in the web space between the toes. They can experience ’shooting’ pains extending into the toe cleft and at the end of the toes.
Symptoms are worse with walking and in narrow shoes, or shoes with a thin and flimsy sole.

What is the non surgical treatment?

Treatment for both conditions is similar.

  • Pain relief – ibuprofen paracetamol (if significant)
  • Activity modification – avoidance of triggers
  • Wearing wider shoes with less heel – generous fitting trainers
  • Metatarsal dome insert – which opens up the space between the metatarsals and reduces symptoms (see image below)
  • Corticosteroid steroid injection – These injections are undertaken regularly in our clinic and can provide immediate and significant relief. A musculoskeletal specialist Sonographer will scan the area to confirm diagnosis and then assist the Podiatrist in guiding the injection into the exact position required. The area is numbed with a local anaesthetic prior to the corticosteroid injection to ensure the procedure is pain free. Mark Hollinshead is our Podiatrist who undertakes these injections.


What is the surgical treatment?

Surgery is reserved for when symptoms have not responded to non surgical treatment and are significant and persistent.
Surgery involves an incision on the top or bottom of the foot in the webspace and the affected nerve is cut, the web space will therefore become numb permantly. This procedure will cure the vast majority of Mortons neuromas.
In intermetatarsal bursitis the bursa is resected often with the nerve.