Morton neuroma

Morton neuroma is a damaged, enlarged nerve that causes pain on the bottom of the forefoot, usually in the area behind the third and fourth toes. The pain is usually sharp or burning. There may be pain, tingling or numbness spreading into these toes.

The exact cause of Morton neuroma is not known, but it’s likely related to pressure on the nerve. High-heeled or narrow shoes may worsen the symptoms of Morton neuroma.

Many people get relief by wearing shoes with low heels and wide toe boxes and by using shoe inserts. Treatments also may include corticosteroid injections or surgery.

Morton neuroma also is called interdigital neuroma.

Morton neuroma causes pain in the ball of your foot. The ball is the padded area of the bottom of the foot between the toes and arch. Usually, the pain is in the area behind and between the third and fourth toes.

The pain is often described as:

• Stabbing, shooting or burning pain in the ball of the foot.
• Feeling as if walking on a marble or stone.
• Pain that increases with activity.
• Pain, a pins and needles feeling, tingling, or numbness in the two nearby toes.
• Pain when stretching toes.
• A clicking sensation in the forefoot.

Pain is often relieved with rest or removing shoes.

When to see a doctor

It’s best not to ignore any foot pain that lasts longer than a few days. See your healthcare professional if you experience a burning pain in the ball of your foot that’s not improving with a change in footwear or activities that put a strain on your feet.

The exact cause of Morton neuroma is not known. Pressure on the affected nerve may contribute to damage and enlargement of the nerve.

The affected nerve is in a space between long bones in the forefoot called the metatarsal bones. Usually, the damaged and enlarged nerve is between the metatarsal bones that connect to the bones of the third and fourth toes. Nerves between other metatarsal bones also may be affected.

Factors that appear to worsen symptoms of Morton neuroma include:

• High-heeled or narrow shoes. High-heeled shoes or shoes with narrow toe boxes can put extra pressure on the toes and the ball of the foot.
• Activities. Walking, running or other activities that put pressure on the ball of the foot may worsen or trigger pain.

Factors that appear to contribute to Morton neuroma include:

• High heels. Wearing high-heeled shoes or shoes that are tight can place extra pressure on your toes and the ball of your foot.
• Certain sports. Participating in high-impact athletic activities such as jogging or running may subject your feet to repetitive trauma. Sports that feature tight shoes, such as snow skiing or rock climbing, can put pressure on your toes.
• Foot deformities. People who have bunions, hammertoes, high arches or flatfeet are at higher risk of developing Morton neuroma.

During the exam, your healthcare professional will ask questions about your symptoms, general health, medical history and typical activities. Your health professional also will examine your foot by:

• Applying pressure at points along the ball of your foot to locate the site of pain.
• Squeezing the ball of the foot and feeling for a click between metatarsal bones.
• Testing the range of motion of the toes.
• Looking for other signs of irregularity in the foot that may contribute to pain.

Imaging tests

Some imaging tests may be used if your healthcare professional would like to confirm a diagnosis of Morton neuroma or rule out another cause of pain. These may include:

• X-rays. An X-ray of your foot while standing can reveal a bone fracture or other bone irregularity in the foot.
• Ultrasound. An ultrasound may be used to confirm a diagnosis of Morton neuroma or spot irregularities in soft tissues in joints.
• Magnetic resonance imaging (MRI). An MRI may also be used to view soft tissues. This imaging may be used to rule out other conditions or when symptoms are not typical.

The first line of treatment is usually to avoid activities that worsen symptoms and change footwear.

Shoes

Changes to shoes that can improve symptoms include the following:

• Avoid high-heeled shoes.
• Wear shoes with wide toe boxes that don’t crowd the balls of the feet.
• Use a ready-made or custom-made shoe insert with padding that cushions and supports the forefoot.

Corticosteroids

A corticosteroid may be injected into the nerve to treat pain. The injection is usually guided with an ultrasound device. The corticosteroid may be combined with a local anesthetic that temporarily numbs the area. This is usually a single injection.

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If other treatments don’t work, your healthcare professional may recommend surgery. Surgical removal of the damaged, enlarged portion of the nerve is called a neurectomy.

This is the most common procedure for treating Morton neuroma. The surgery is usually successful, but there may be permanent numbness in the affected toes.

Other procedures that haven’t been studied extensively may be used. These include procedures that:

• Disable the affected nerve without removing it.
• Create more space for the nerve in the forefoot by cutting tissues that connect bones.

To help relieve the pain of Morton neuroma and allow the nerve to heal, consider the following self-care tips:

• Take anti-inflammatory medicines. Nonprescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), may relieve pain.
• Try ice massage. Regular ice massage may help reduce pain. Freeze a water-filled paper or foam cup and roll the cold cup over the painful site.
• Change your footwear. Have your feet measured at a shoe store to make sure you are buying shoes of the correct size and width. Avoid high heels or tight shoes. Choose shoes with wide toe boxes.
• Take a break. For a few weeks, reduce activities such as running, jumping, climbing or dancing that subject the balls of your feet to high impact.

You’ll likely see your primary healthcare professional first. You may be referred to a doctor or surgeon who specializes in foot conditions.

What you can do

Before your appointment, you may want to write a list of answers to the following questions:

• When did your symptoms begin?
• Did your symptoms begin gradually or suddenly?
• What type of footwear do you wear for work and recreation?
• Do you participate in sports? If so, what types in particular?
• What medicines and supplements do you take regularly?

What to expect from your doctor

Your healthcare professional may ask some of the following questions:

• How would you describe the pain?
• Do you feel any tingling or numbness in your foot or toes?
• Is the pain worse when wearing certain shoes?
• Do certain activities worsen the pain?
• Does anything lessen the pain? What home remedies have you tried?
• Are you experiencing any other pain in your body?