Morton's Neuroma

What is a Morton’s Neuroma?

A Morton’s neuroma is not really a nerve tumor like the name suggests, rather degeneration and thickening of the nerve. The nerve becomes inflamed and irritated and overtime it can become damaged and develop scar tissue. The nerve between the third and fourth toes is particularly susceptible to this because it is thicker by nature than the other nerves in the forefoot. Wearing shoes that are too narrow can cause this problem as it compresses the nerve. Neuromas also tend to occur in people that have a wide forefoot or that participate in high impact activities such as running.

Symptoms

  • Tingling or numbness in the third and fourth toes.
  • Burning pain along the ball of the foot near the third and fourth toes.
  • Feeling like something is in your shoe or there is a wrinkle in your sock.
     

Typically neuroma symptoms begin only when wearing shoes. When you take your shoes off the pain symptoms tend to subside. However, as time goes on and the nerve damage continues pain may be constant.

Diagnosis

X-rays will usually be taken initially. Sometimes an MRI or a diagnostic injection with local anesthetic can be helpful. The majority of the time a neuroma is diagnosed based on clinical symptoms.

Nonsurgical Treatment: Conservative treatment is sucessful in most cases of Morton's neuroma.

  • Shoes: Wearing shoes with a stiff sole and rocker bottom can be very helpful. It is important that the toe box be wide enough to accommodate your forefoot.
  • Custom Orthotics: Orthotics with a metatarsal pad combined with appropriate shoes can be very effective at reducing symptoms.
  • Calf stretching: This should be incorporated into a daily routine to decrease pressure at the ball of the foot.
  • Modifying activities: Changing activities can be an effective nonsurgical treatment. Consider bicycling instead of running. Make a conscious effort to kneel with you foot flat, instead of bending at the forefoot when you are working in the garage or garden. High impact activities on the ball of your foot as well as crouching aggravate your neuroma and should be avoided.
  • Injections: Serial steroid injections can help reduce inflammation to the nerve. Serial alcohol injections can be performed which have a higher affinity to nerve tissue and are used to chemically destroy the nerve.

Surgical Treatment

Surgical treatment can be considered when conservative treatment is exhausted. The surgical treatment involves removing the nerve that has been damaged between the third and fourth toes. This will cause permanent numbness but can be effective at eliminating pain.  One complication is the formation of a stump neuroma where the nerve degenerates and remains painful where it was cut. If this occurs, the surgery must be repeated. Immobilization in a cast and non-weightbearing for around three weeks is necessary after surgery. 


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