Morton’s Neuroma

Morton’s neuroma (intermetatarsal neuroma) describes a benign but painful disorder affecting the ball of the foot. It usually forms between the metatarsal bones within the ball of the foot. It develops when the tissue around a nerve that runs to the toe thickens because of irritation or compression.

Morton’s neuroma mostly appears between the third and fourth toes, although it can also occur between the second and third toes. This condition primarily affects middle-aged people, especially women.

Symptoms

The symptoms of Morton’s neuroma typically develop gradually, starting with mild discomfort and potentially advancing to more severe pain and irritation. The common symptoms are:

• Pain is usually felt between the toes, mainly when standing or walking.
• Increased pain when standing on the balls of the feet or wearing high-heeled shoes.
• Swelling that can be noticeable between the toes.
• Tingling and numbness in the foot.

In the early stages, symptoms may be mild and relieved by rest, removing tight footwear, or foot massages. However, as inflammation progresses, the symptoms tend to become more severe and persistent.

Causes

Morton’s neuroma results from irritation and swelling of the nerve between the toe bones. Although the exact reason for the inflammation is unclear, stress on the toes, the nerves between them and the ball of the foot are considered primary triggers. Activities and conditions that may raise the risk of Morton’s neuroma involve:

• Wearing high heels or shoes with narrow, sharp toes.
• Participating in sports that put significant stress on the balls of the feet, like tennis, running, or other racquet sports.
• Engaging in physical work requiring extended periods of standing.

These foot disorders may also make individuals more prone to Morton’s neuroma:

• Flat feet
• High arches
• Hammertoes
• Bunions
• Foot injuries; like those caused by sports-related trauma or accidents.

Diagnosis

Morton’s neuroma diagnosis usually begins with a physical examination. A podiatrist (a foot care specialist) may be consulted for a more precise diagnosis.

Physical examination:

The physician will examine the feet, ask when the symptoms began and identify activities or positions that worsen them. Light pressure may be applied to the spaces between the toe bones while observing the patient’s reaction during walking, standing, or movement.

Diagnostic tests:

While a foot X-ray cannot show a neuroma, it helps rule out other disorders causing foot pain, like arthritis or stress fractures. If additional examination is needed, these additional tests may be used:

• Ultrasound: Provides detailed images of the nerve and adjacent tissue.
• Electromyography (EMG): This may be recommended if ultrasound results are indecisive. It helps rule out other conditions that may mimic Morton’s neuroma symptoms.

Treatment

Morton’s neuroma treatment primarily aims to alleviate symptoms and reduce inflammation within the affected nerve. At The Joint Pain Clinic, we recommend the following options:

Non-surgical treatment:

• Footwear changes: Wearing shoes with broad, deep-toe boxes can lessen stress on the affected nerve. Also, a stretching device may help broaden existing footwear.
• Shoe pads: Non-prescription shoe pads cushion around the nerve and ease pressure.
• Orthotic devices: These shoe inserts support the feet and help maintain proper toe positioning. They can be purchased over the counter or customized.
• Pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to relieve pain and swelling.
• Icing: Ice or cold packs applied on the affected foot can ease pain and reduce inflammation.
• Corticosteroids: These prescription drugs can help minimize inflammation. Cortisone injections may also be recommended for additional relief.

Surgical treatment:

The doctor can recommend surgery as a last option when other treatments are not effective or when walking is extremely painful.

Surgical procedures that can be performed include:

• Neurectomy: Involves removing part of the affected nerve. It is the most common surgical treatment for Morton’s neuroma.
• Cryogenic neuroablation: Uses extreme cold to kill targeted nerve cells in order to reduce inflammation and sensitivity in the nerve.
• Radiofrequency ablation: Uses electrical currents to eradicate a small fraction of the affected nerve tissue with high heat. This prevents pain signals from reaching the brain.