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 a Morton’s neuroma, which occurs between the third and fourth toes. Neuromas may also occur in other locations on the foot. The incidence of Morton's neuroma is 8 to 10 times greater in women than in men.

The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve and could eventually lead to permanent nerve damage.

Symptoms

If you have a Morton’s neuroma, you may 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
  • A feeling that there is something in you shoe or your sock is bunched up

The progression of a Morton’s neuroma often follows a typical pattern:

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

Causes

Anything causing compression or irritation of the nerve can lead to the development of a neuroma. One of the more 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, such as bunions, hammertoes, flatfeet, or more flexible feet, are at a higher risk for developing a neuroma. Other potential causes include activities that involve repetitive irritation to the ball of the foot, such as running or court sports. An injury or other type of trauma to the area may also lead to a neuroma.

Treatment Options

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

In developing a treatment plan, your doctor will first determine how long you’ve had the neuroma and evaluate its stage of development. Treatment approaches vary according to the severity of the problem.

For mild to moderate neuromas, treatment options may include:

  • Padding. Padding techniques provide support for the metatarsal arch, lessening the pressure on the nerve and decreasing the compression when walking.
  • Icing. An icepack on the affected area can help reduce swelling.
  • Orthotic Devices. Custom orthotic devices provided or prescribed by SBO may 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.
  • Shoe Modifications. Wear shoes with a wide toe box, avoiding narrow-toed shoes or shoes with high heels.
  • Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
  • Injection Therapy. Treatment may include injections of cortisone, local anesthetics or other agents.

Surgery may be considered in patients who have not responded adequately to non-surgical treatments. Your foot and ankle surgeon will determine the approach that is best for your condition.

Recovery

Regardless of whether you’ve undergone surgical or nonsurgical treatment, your SBO surgeon will recommend long-term measures to help keep your symptoms from returning. These include appropriate footwear and modification of activities to reduce the repetitive pressure on the foot. The length of the recovery period will vary, depending on the procedure performed.