The Cost of Morton’s Neuromas (Metatarsalgia)
A neuroma is a benign swelling / lump on a nerve, and they are quite commonly found in the feet between the base of the toes and the joints that make up the balls of the feet (the metatarso-phalangeal joints – MTPJs).
Morton’s neuromas are specifically located in the 3rd interspace (between the 3rd & 4th toes / MTPJs), with those found in adjacent areas having different names – Heuter’s, Howser’s, Iselin’s, and Joplin’s neuromas.
Patients with neuromas are commonly given the diagnosis of “metatarsalgia”, but that isn’t a real diagnosis of a specific problem. It means pain around the metatarsal area of the feet (so a broad descriptive term similar to saying “headache”). Possible specific diagnoses for that include neuromas, synovitis, capsulitis, tendonitis, plantar plate injury, stress fracture, and fat pad irritation.
Neuromas can be frustrating. On some days in some footwear during some activities, they can be painless. On other days in other footwear during other activities, they can cause intense radiating pain. They can also cause pins & needles in the forefoot or a feeling that your socks are rucked up in your shoes.
They do not show up on X-rays, but can be seen on ultrasound & MRI scans, although they are fairly indistinguishable from bursae which are deep fluid-filled sacks associated with the joints. Indeed scan reports will often state “neuroma / bursal complex found”.
NHS guidelines on the treatment of neuromas advise 3 stages to resolution. First line treatment is the use of metatarsal pads on the foot or in footwear integrated with special insoles (orthoses / orthotics) if necessary. Second line treatment is steroid injections with or without ultrasound guidance. Third line treatment is removal of the neuroma and affected nerve which results in permanently numb areas on your toes.
However, there are other treatment options available privately with differing success levels including toe spacers (off-the-shelf or bespoke), joint mobilisations / manipulations, high intensity laser therapy, cryosurgery, alcohol injections, and nerve decompression surgery.
So what about the costs of neuromas? As always, these can be split into 3 categories:
Physical costs – To avoid pain associated with neuromas, people often walk differently with what healthcare professionals call an antalgic gait. If this continues over a period of time, then new problems can arise associated with altered / reduced physical activity such as weight gain or additional musculo-skeletal issues.
Emotional costs – Like other painful foot conditions, there is the effect that intermittent pain can have on mental health as it can be draining and lead to depression.
Financial costs – Before a patient seeks help for their neuroma(s), they often spend quite significant amounts of money on home remedies and footwear. NHS treatments are free, but they are limited as explained above. If you want to explore the other available treatment options then private healthcare will be the route to go. The fees charged by good Podiatrists would range from below £100 to above £500 depending on the intervention(s) required. Other healthcare professionals such as physiotherapists, chiropractors, osteopaths etc. may have similar costs associated with their treatment packages. Surgical interventions would then be more expensive.
As with all foot-related problems I have discussed in this series of articles, there really is no need to suffer or put up with pain in your feet. Just see a good Podiatrist who will be able to help you back to comfort to do the activities you enjoy. To find out more about what good Podiatry is, then listen to this podcast I was invited to record: Podiatry Legends Podcast: 150 – Jonathan Small What is Good Podiatry?
Jonathan Small, Lead Podiatrist, Health First Foot & Gait Clinic, 01926 811272
“Following my appointment today I would highly recommend Health First. A detailed history of my symptoms was taken, followed by a thorough foot examination and gait analysis. The advice and explanation I received was first class and also included a medical referral for further investigation into my foot pain. I was also impressed that Jonathan actually asked me to let him know the outcome of my condition, even though no further appointments with Health First are indicated. My only regret is I should have made an appointment sooner.” M.H., Leamington Spa