Morton’s neuroma is a benign, or non-cancerous, growth of nerve tissue that develops in the foot, usually between the third and fourth toes. It is a common and painful condition.
It is also known as Morton’s metatarsalgia, Morton’s disease, Morton’s neuralgia, Morton metatarsalgia, Morton nerve entrapment, plantar neuroma, and intermetatarsal neuroma.
It is due to a swollen nerve in the ball of the foot, normally between the base of the third and fourth toes.
Patients with Morton’s neuroma may need to change their footwear, take painkillers, or have steroid injections. In some cases, surgery may be needed to remove the affected nerve or release the pressure on it.
Treatment depends on several factors, including:
- the severity of symptoms
- how long they have been present
- whether home treatment has been tried
The earlier the condition is diagnosed, the less likely the person is to need surgery.
If symptoms are severe or persistent, and self-help measures do not help, the doctor may recommend:
- Corticosteroid injections: A steroid medication that reduces inflammation and pain is injected into the area of the neuroma. Only a limited number of injections are advised, as there may be side effects. These include hypertension (high blood pressure) and weight gain.
- Alcohol sclerosing injections: Studies have shown that alcohol injections reduce the size of Morton’s neuromas as well as alleviating pain. Injections are typically administered every 7 to 10 days. For maximum relief, between four and seven injections are usually needed.
Morton’s neuroma surgery
If other therapies have not worked and symptoms persist after 9 to 12 months, it surgery may be advised.
Surgery is usually effective, but it can result in permanent numbness in the affected toes. This is why doctors recommend trying other options first.
Surgery involves either removing the nerve or removing the pressure on the nerve by cutting surrounding ligaments or fibrous tissue.
Two surgical approaches are possible:
- Dorsal approach: The surgeon makes an incision on the top of the foot, allowing the patient to walk soon after surgery because the stitches are not on the weight-bearing side of the foot.
- Plantar approach: The surgeon makes an incision on the sole of the foot. During recovery, most patients will need to use crutches for about 3 weeks. The resulting scar might make walking uncomfortable. However, the neuroma can be reached easily and removed without cutting any structures.
There is a small risk of infection around the toes after surgery.
Patients experience numbness and pain in the affected area, which is relieved by removing footwear and massaging the foot.
In Morton’s neuroma, the tissue around one of the nerves leading to the toes thickens, causing a sharp, burning pain in the ball of the foot.
Outward signs of Morton’s neuroma, such as a lump, are extremely rare. Morton’s neuroma signs and symptoms usually occur unexpectedly and tend to worsen over time.
The main symptom is pain when the foot bears weight. A shooting pain may affect the adjacent sides of two toes. It may be felt after only a short time of walking.
Sometimes, there may be a dull pain rather than a sharp one. Most commonly, pain is felt between the third and fourth toes. Typically, a patient will suddenly experience pain while walking and will have to stop and remove their shoe.
Other symptoms include:
- burning pain, often described as like a “red hot needle,” which can start suddenly while walking
- numbness may affect the toes
- paresthesia, a tingling, pricking, or numbness with no apparent long-term physical effect, commonly known as pins-and-needles
- a sensation that something is inside the ball of the foot.
Many patients describe the sensation as a burning pain in the ball of the foot that often radiates to the toes.
Initially, the pain might become much more apparent when the person wears tight, narrow, or high-heeled shoes, or engages in activities that place pressure on the foot. Symptoms may be continuous and last for days, and even weeks.
Symptoms can become so severe that affected individuals become anxious about walking or even placing their foot on the ground. In some cases, however, the neuroma is symptomless; MRI scans sometimes reveal Morton’s neuroma lesions in patients who have no symptoms at all.
Morton’s neuroma responds well to rest, but if pain levels allow, some stretching and strengthening exercises may help to maintain and improve strength in the arch of the foot.
These include exercises to:
- stretch the lower leg, calf, and achilles muscles
- stretch the plantar fascia along the bottom of the foot
Exercise should start slowly, to stop the nerve from becoming inflamed again.
Here are some simple exercises:
To stretch the plantar fascia, take the heel in one hand and place the other hand under the ball of your foot and toes. Gently pull back the front of the foot and the toes toward the shin.
You can also do this exercise by sitting with your feet out in front of you, and gently pulling the toes back toward the shin with the hand. In time, you may be able to pull the toes back without using the hand.
To stretch the foot roll it back and forth over a bottle on the floor.
To strengthen the foot, make figure-of-eight patterns with the foot, leading with the big toe.
Athletes might return to activity through a routine that gets gradually tougher.
A physical therapist might suggest walking for 4 minutes and jogging for 2 minutes, repeating four times on the first day, then, on the second day, resting. Exercising on alternate days, the athlete can gradually increase the time spent on more strenous exercise.
In 2012, a researcher reported that one patient experienced some relief from pain as a result of therapeutic massage.
Six sessions of massage therapy were given, once a week, each lasting 60 to 75 minutes. The participant also completed the exercise described above to stretch the plantar fascia at home each day. The massage focused on postural alignment and treating the leg and foot.
After three sessions, the patient reported that her pain had changed from burning and stabbing to dull and pulsing.
Self-help measures for Morton’s neuroma include:
- resting the foot
- massaging the foot and affected toes
- using an ice pack, wrapped in a cloth, on the affected area
- using arch supports a type of padding that supports the arch of the foot and removes pressure from the nerve
- wearing broad-toed shoes, to allow toes to spread out and reduce friction
- taking over-the-counter (OTC) painkilling medications
- modifying activities, for example, avoiding or taking a break from activities that put repetitive pressure on the neuroma, until the condition improves
- managing or reducing bodyweight management, as this can improve symptoms in people with excess weight
- doing strength exercises, to strengthen the foot muscles
Several types of orthotic devices or arch supports, metatarsal pads or bars are available over the counter. These can be placed over the neuroma.
Taking measures to reduce pressure will help reduce the level of pain.
A doctor or a podiatrist (foot specialist) will ask the patient to describe the pain and its intensity and when symptoms started. They will also ask what types of shoes they wear and about their job, lifestyle, and hobbies.
The doctor will examine the foot and try to locate the affected nerve. This may involve attempting to reproduce symptoms by manipulating the foot. The doctor might also perform a maneuver to elicit a feeling of “clicking” between the toes, this is a sign for Morton’s neuroma.
In order to get a detailed image of the inside of the foot, one of the following scans may be ordered:
- X-rays can rule out other foot injuries, such as a stress fracture.
- Ultrasound scans – are relatively cheap, require no radiation, and can identify Morton’s neuroma with a similar accuracy to an MRI. It can also help distinguish Morton’s neuroma from other similar conditions, such as synovitis.
- MRI is a more expensive imaging test that can detect Morton’s neuroma, even when there are no symptoms.
The doctor will have to rule out other conditions with similar symptoms, including capsulitis, bursitis, or Freiberg’s disease.
Experts are not sure exactly what causes Morton’s neuroma. It seems to develop as a result of irritation, pressure, or injury to one of the nerves that lead to the toes; this triggers a response, resulting in thickened nerve tissue (neuroma).
A high percentage of patients with Morton’s neuroma are women who wear high-heeled or narrow shoes.
Conditions and situations that can cause the bones to rub against a nerve include:
- high-heeled shoes, especially those over 5 centimeters
- shoes with a pointed or tight toe box that squashes the toes together
- high-arched feet
- flat feet, when the entire sole comes into contact with the ground
- a bunion, a localized painful swelling at the base of the big toe that enlarges the joint
- hammer toe, a deformity within a joint of the second, third, or fourth toe that causes it to be permanently bent
- some high-impact sporting activities, including running, soccer, tennis, karate, and basketball
- injury or trauma to the foot
The impact of high heels and narrow-toed shoes probably explain why the condition is more common in females than males.