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Diseases & Conditions

Morton's Neuroma

What is Morton’s neuroma?

Morton’s neuroma is inflammation, thickening, or enlargement of the nerve between the bones of the toes (metatarsal bones). The condition is also called intermetatarsal neuroma. The thickening is usually found between bones of the third and fourth toes of the foot, but sometimes it may develop between the second and third toes. It occurs when the medial plantar nerve near the bones of those toes becomes compressed or irritated, possibly because the metatarsal bones press against the nerve in the narrow gap between the toes.

If left untreated, Morton’s neuroma can cause a sharp, burning, or shooting pain that often gets worse over time. The pain becomes worse when a person walks or stands on the ball of the foot.  Sometimes the pain reaches the toes next to the neuroma and a sensation of tingling or numbness is felt.

What causes Morton’s neuroma?

The exact cause of Morton’s neuroma is not known, but the choice of footwear seems be a factor. Wearing high heels (shoes with heels over 2 inches) can put extra pressure on the balls of the feet. Wearing tight or pointed toed shoes may squeeze the toes together or otherwise constrict their movement. For that reason, women are about 8 to 10 times more likely to develop Morton’s neuroma compared with men.

Who gets Morton’s neuroma?

People who are born with flat feet, high arches, or an abnormal position of the toes are more prone to developing Morton’s neuroma. This may be due to instability around the toe joints. Certain conditions that develop over time, such as bunions or hammer toes, are also associated with Morton’s neuroma. Some sports that involve running, including tennis and other racquet sports, can also increase the chance of developing Morton’s neuroma due to trauma or injury to the foot.

What are the symptoms of Morton’s neuroma?

  • A sharp or stinging pain between the toes when standing or walking
  • Pain in the forefoot between the toes
  • Swelling between the toes
  • Tingling (“pins and needles”) and numbness
  • Feeling like there is a “bunched up sock” or a pebble or marble under the ball of the foot

How is Morton’s neuroma diagnosed?

You should visit a doctor or podiatrist (foot doctor) if you have pain or tingling that does not stop. Your health care provider will examine your feet and will apply pressure on the spaces between the bones of the toes to determine the location of the foot pain. The doctor may order X-rays to rule out other conditions associated with foot pain, such as a stress fracture or arthritis. X-rays alone will not show whether or not a neuroma is present, so an ultrasound scan or magnetic resonance imaging (MRI) test may be done to confirm the diagnosis. A diagnostic procedure called an electromyography is sometimes used to rule out nerve conditions that may cause symptoms like those of associated with Morton’s neuroma.

How is Morton’s neuroma treated?

There are various options for treating the condition, depending on its severity.

Self-treatment—Here are some simple steps that may improve symptoms.

  • Wear supportive shoes with a wide toe box. Do not lace the forefoot of the shoe too tightly. Shoes with shock-absorbent soles and proper insoles are recommended.
  • Do not wear tight or pointed toed shoes or shoes with heels more than 2 inches high.
  • Use over-the-counter shoe pads to relieve pressure.
  • Apply an ice pack to the affected area to reduce pain and swelling.
  • Rest your feet and massage the painful area.

Medications—There are drugs that may temporarily relieve the pain and other symptoms of Morton’s neuroma. Long-term use of these medications is not recommended.

  • Cortisone shots
  • Anti-inflammatory drugs—Nonsteroidal anti-inflammatory drugs, such as ibuprofen or aspirin, may be taken orally to reduce pain and inflammation. Anti-inflammatory drugs can also be administered by direct injection into the skin.
  • Local anesthetic—An anesthetic injection will temporarily relieve pain by numbing the affected nerve.

Orthotics—These are custom-designed shoe inserts that can reduce some of the pain associated with Morton’s neuroma. Sometimes padding is placed around the toe area, and tape is applied to hold the padding in place.

Surgery—When medications or other treatments do not work, podiatric surgery may be required. The most common surgical procedure for treating Morton’s neuroma is a neurectomy, in which part of the nerve tissue is removed. Although this procedure effectively removes the original neuroma, sometimes scar tissue known as a stump neuroma forms at the site of the incision. This may result in tingling, numbness, or pain following surgery.

Surgery is effective in relieving or reducing symptoms for Morton’s neuroma patients in about 75% to 85% of all cases.

Occasionally, minimally invasive radio frequency ablation is also used to treat Morton's neuroma.

How can Morton’s neuroma be prevented?

  • Do not wear tight shoes or high-heeled shoes for prolonged periods.
  • Do wear shoes with a wide toe box so that your toes are not squeezed or cramped.
  • Do wear athletic footwear with enough padding to cushion the balls of the feet when exercising or participating in sports.
References
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This article was reviewed by Georgeanne Botek, DPM. Dr. Botek is Medical Director of the Diabetic Foot Clinic. Her areas of interest also include foot surgery, and all skin, nail and musculoskeletal pathology involving the foot and ankle.

 

 

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 10/25/2012...#15118

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