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Morton’s Neuroma


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20 Jun 2015

Britain’s oldest surgical Royal College saw new research presented at their annual President’s Meeting evaluating treatments for a condition becoming increasingly common in middle-aged women. Morton’s Neuroma; a painful ailment of the foot thought to be brought on by years of wearing high-heeled and/or ill-fitting shoes; has risen by 115% in the last decade.

The study on this rising complaint was presented during the Audit Symposium at the Royal College of Surgeons of Edinburgh (www.rcsed.ac.uk), which last year opened its first-ever centre of operations in Birmingham to cater for the 80% of its UK membership based in England and Wales.

According to the American Academy of Orthopaedic Surgeons, women are eight to ten times more likely than men to suffer from this condition, and UK statistics by the Health and Social Care Information Centre show that diagnoses in women aged 40-69 have risen by 115% since 2004.

Morton’s Neuroma is a relatively common condition, affecting the nerve that runs between the toes. Fibrous tissue develops around the nerve, which then becomes compressed, causing pain (ranging from ‘feeling like there’s a pebble inside the shoe’ to ‘walking on razor blades’) in the space between the toes. The new research revealed that over half of patients required surgery to alleviate symptoms.

Orthopaedic research Fellow Andrew Craig, based at Bradford Teaching Hospitals Foundation Trust, reviewed patient admissions and treatment for Morton’s – also known as interdigital or intertarsal – Neuroma, a complaint he says is widely misunderstood. Andrew, originally from Shropshire, says:

"The name Morton's Neuroma implies a tumour, which is misleading; this condition involves the nerves in the foot but is not cancerous as the name suggests. Morton's neuroma is a historically well documented, but poorly understood phenomenon that can be tackled in a few different ways. I looked into these treatment outcomes because I suspected that, although simple treatments for Morton's Neuroma are often effective, the success rate of a surgical procedure may be undersold. We have known for a long time that the condition seems to predominantly affect females of a middling age, with speculation that high heels and other such tightly fitting and unnatural footwear (despite looking fabulous, I'm sure) may play a role. Increasing awareness of Morton's Neuroma can only be a good thing; not least because numbness in the foot could be a sign of other, potentially life-altering, conditions, such as diabetes.”

Morton’s Neuroma can be treated using specially designed insoles and steroid injections, but these treatments aren’t always successful. In such cases, surgery is the only option, which involves decompressing the nerve through an incision between the affected toes. Sometimes surgery will involve complete removal of the compressed nerve, leaving the patient with no feeling between the affected toes.

Andrew Craig’s study, titled ‘The Role and Efficacy of Conservative Management in the Treatment of Morton’s Neuroma’ was conducted to ascertain the success rates of different types of treatment. Over a period of 5 years, 40 cases were studied. 32 of the cases (80%) were female, with an average age of 47 years old. Over half (55%) of the cases required surgery to resolve their painful symptoms. The research was presented at the College’s Research Symposium, which took place at the end of March during their annual President’s Meeting. Mr Craig concludes:

I was very grateful to be able to share my work at the Symposium; it's a great opportunity for trainees to present their work on a national stage.”

According to the RCSEd President Mr. Ian Ritchie, who is also a consultant trauma and orthopaedic surgeon:

“Highlighting emerging trends and exploring statistical data regarding the effectiveness of treatments is extremely valuable to the surgical community, and by extension, to patients. Our Audit Symposium is an ideal platform to share knowledge and best practice on the management of health conditions – especially those that are on the rise and perhaps less widely understood, such as Morton’s Neuroma.”

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