Morton’s Neuroma

Morton’s neuroma refers to a nerve injury between the toes, usually the third and fourth toes, which causes pain and thickening of the nerve tissue.

The symptoms of Morton’s Neuroma include:

• Burning pain in the ball of the foot
• Burning pain radiating to the toes
• Numbness in the affected toes
• Inability to walk

Causes

Compression or chronic irritation of this interdigital nerve is the main cause of Morton’s Neuroma. Excess pressure is exerted on the nerves by narrowing of the gap between the toe bones. This causes thickening of the nerve tissue from scar tissue formation. Swelling of the nerve and the surrounding tissue result.

Morton’s neuroma is more common in women than in men. Wearing high-heeled or narrow shoes squeezes the toe bones and creates or worsens these symptoms.

Diagnosis

Your doctor can diagnose Morton’s Neuroma by examining your foot. Palpation of the foot between the toes may reveal a thickened and tender area. A foot x-ray may also be ordered to confirm the diagnosis.

Treatment

Early treatment is critical to relieve pain. Mild to moderate cases of Morton’s Neuroma can be managed by conservative treatment.

The conservative treatment measures include:

• Resting the foot
• Application of ice packs to reduce swelling.
• Anti-inflammatory medications to help alleviate pain and inflammation
• A corticosteroid injection may be given if the symptoms do not improve with non-invasive treatments.
• A neurolytic injection may be given if the symptoms do not improve with other treatments.
• Footwear modifications may be recommended including:
  1. wearing low-heeled shoes
  2. broad toe box shoes with special pads to minimize discomfort between the toes.
  3. Metatarsal pads may be recommended to transfer pressure away from the ball of the foot.
  4. Stiffer soled closed back shoes or stiff sandals with a strap on the back also decrease loading through the forefoot.
• Physical therapy to relieve the pressure and improve the foot function. This is most helpful to improve calf flexibility and decrease forefoot loading.

Severe cases of neuroma may require surgery.
If the symptoms fail to resolve with conservative treatments or the nerve damage is severe, surgery may be considered. Surgical treatment may include decompression (neurolysis) or resection of the involved nerve (neurectomy) or the surrounding tissue.