What is Morton's neuroma?

A Morton's neuroma is inflammation (swelling), 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 often can develop between the second and third toes, as well. It occurs when the nerve becomes compressed (squeezed) or irritated, possibly because the metatarsal bones press against the nerve in the narrow gap between the toes.

If it is not treated, a plantar interdigital 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 or wears higher-heeled shoes. Pain can spread into the nearby toes, and can give the feeling of a bunched-up sock.

What causes Morton's neuroma?

The exact cause of Morton's neuroma is not known, but the choice of footwear seems to be a factor. Wearing high heels (shoes with heels more than 2 inches high) can put extra pressure on the balls of the feet. Wearing tight-fitting narrow or pointed-toed shoes may squeeze the toes together or limit their movement. For that reason, women are about 8 to 10 times more likely to develop a 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, and the elliptical forces, increase pressure on the ball of the foot, and 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 is affecting your ability to walk pain-free. Your physician 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 make sure the diagnosis is correct.

A diagnostic procedure called an electromyography is sometimes used to rule out nerve conditions that may cause symptoms like those of Morton's neuroma. Usually, the diagnosis can be made by your symptoms and physical exam alone.

How is Morton's neuroma treated?

There are various ways to treat Morton's neuroma, depending on how severe it is.

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. You should not use these medications for a long time.

  • Corticosteroid injection (shot)
  • Alcohol sclerosing injections
  • Anti-inflammatory drugs—Nonsteroidal anti-inflammatory drugs, such as ibuprofen or aspirin, may be taken orally (by mouth) to reduce pain and inflammation. Anti-inflammatory drugs can also be given 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 of Morton's neuroma. Often a metatarsal pad is placed on your foot insole or shoe insole to offload (take the pressure off) the painful nerve.

Surgery—When medications or other treatments do not work, foot surgery may be needed. The most common surgical procedure for treating Morton's neuroma is a neurectomy, in which part of the nerve tissue is removed.

A procedure that may be performed before a neurectomy, or in place of a neurectomy, is called cryogenic neuroablation therapy. During this procedure, extremely cold temperatures are applied to the nerves to destroy nerve cells and the myelin sheath that covers the nerve. The temperatures used in cryosurgery range from -50 degrees to -70 degrees Celsius. Patients who have cryogenic neuroablation are less likely to see symptoms return.

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

How can Morton's neuroma be prevented?

  • Do not wear tight shoes or high-heeled shoes for long 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 you are exercising or taking part in sports.

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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: 3/3/2016...#15118