Morton's Neuroma

A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is Morton’s neuroma, which occurs at the base of the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma. “Intermetatarsal” describes its location — in the ball of the foot between the metatarsal bones (the bones extending from the toes to the midfoot). Neuromas may also occur in other locations in the foot. The thickening, or enlargement, of the nerve that defines a neuroma, is the result of compression and irritation of the nerve. This compression creates swelling of the nerve, eventually leading to permanent nerve damage.

What are the causes of Morton’s Neuroma?

Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box, or high–heeled shoes that cause the toes to be forced into the toe box.

People with certain foot deformities — bunions, hammertoes, flatfeet, or more flexible feet are at higher risk for developing a neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or racquet sports. An injury or other type of trauma to the area may also lead to a neuroma.

What are the symptoms of Morton’s Neuroma?

If you have Morton’s neuroma, you will probably have one or more of these symptoms where the nerve damage is occurring:

• Tingling, burning, or numbness
• Pain
• A feeling that something is inside the ball of the foot, or that there’s a rise in the shoe or a sock is bunched up

The progression of Morton’s Neuroma often follows this pattern:

• The symptoms begin gradually. At first, they occur only occasionally, when wearing narrow-toed shoes or performing certain aggravating activities.
• The symptoms may go away temporarily by massaging the foot or by avoiding aggravating shoes or activities.
• Over time the symptoms progressively worsen and may persist for several days or weeks.
• The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.

What are the treatments for Morton’s Neuroma?

For mild to moderate cases of neuroma, treatment options include:

• Padding: Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.

• Icing: Placing an icepack on the affected area helps reduce swelling.

• Orthotic devices: Custom orthotic devices provided by your podiatric surgeon provide the support needed to reduce pressure and compression on the nerve. 

• Activity modifications: Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.

• Changes in shoewear: It’s important to wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.

• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation.

• Injection therapy: If there is no significant improvement after initial treatment, injection therapy may be tried.

Diagnosis for Morton’s Neuroma

To arrive at a diagnosis, the podiatric foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor attempts to reproduce your symptoms by manipulating your foot. Other tests may be performed.

The best time to see your podiatric surgeon is early in the development of symptoms. Early diagnosis of Morton’s neuroma greatly lessens the need for more invasive treatments and may avoid surgery.