Morton's Neuroma

Overview

What is Morton’s neuroma?

Morton’s neuroma affects your forefoot or ball of your foot, between the metatarsal bones and toes. It’s also called intermetatarsal neuroma. When you have Morton’s neuroma, the nerve between the bones of your toes may become swollen and inflamed. You usually feel it on the bottom of your foot, between your toes. The neuroma can feel painful and make it hard to walk.

Getting treatment for Morton’s neuroma is important. The neuroma can become larger without treatment. The nerve damage may become permanent.

Is Morton’s neuroma a tumor?

The “neuroma” in Morton’s neuroma is slightly misleading. Neuromas are noncancerous (benign) tumors found on nerves throughout the body. They involve a growth of extra nerve tissue.

With Morton’s neuroma, there’s no growth and no tumor. Instead, the existing tissue around the nerve becomes inflamed and gets bigger.

Where does Morton’s neuroma happen?

Usually, the neuroma happens between the bones of your third and fourth toes. Those are the two toes closest to the pinky toe (toe No. 5). But Morton’s neuroma can form between the second and third toes as well.

You develop the condition when the nerve suffers excessive pressure or compression between the toes. That compression (squeezing) causes inflammation and irritation.

Who gets Morton’s neuroma?

You may face a higher risk of developing Morton’s neuroma from:

  • Foot shape: If you were born with flat feet, high arches or toes in an unusual position, you might have instability around the toe joints. That instability can lead to Morton’s neuroma.
  • Certain medical conditions: Some foot conditions that develop over time can raise your risk of developing Morton’s neuroma. Examples include bunions and hammertoes.
  • Sports: Sports such as running, tennis and other racquet sports require a lot of pressure on the balls of your feet as you run. Athletes are also more likely to injure their foot, which can lead to Morton’s neuroma.
  • Shoe choice: High heels (more than 2 inches high) can cause problems. So can tight-fitting, narrow or pointed-toe shoes. All these shoes put extra pressure on the balls of your feet and limit toe movement.

How common is Morton’s neuroma?

About 1 in 3 people have Morton’s neuroma. It occurs more often in women than men, likely because of shoe styles. Women are about 8 to 10 times more likely than men to develop Morton’s neuroma.

Symptoms and Causes

What causes Morton’s neuroma?

An irritated or damaged nerve between the toe bones causes Morton’s neuroma. You feel it on the ball of your foot. Common causes of the nerve reacting this way include:

  • Being born with a congenital foot problem.
  • Pressuring the ball of the foot while running during certain sports.
  • Wearing shoes that prioritize style over support.

What are the symptoms of Morton’s neuroma?

You may not see noticeable signs of Morton’s neuroma on your foot. Since it’s not a tumor, you won’t see a lump, for example. You may feel some pain at first, though it tends to start slowly. In the beginning, you can often improve your symptoms by taking your shoe off and massaging your foot.

Symptoms of Morton’s neuroma get worse over time. These symptoms include:

  • Sharp, stinging or burning pain between the toes when you stand or walk.
  • Swelling between the toes.
  • Tingling (feeling pins and needles) and numbness in your foot.
  • Sense there’s a bunched-up sock or small rock under the ball of your foot.
  • Pain that’s worse when you wear high-heeled shoes or stand on the balls of your feet.

Diagnosis and Tests

How is Morton’s neuroma diagnosed?

During an examination, your healthcare provider will:

  • Look at your feet, to see if there’s a mass between the toes.
  • Put pressure on the spaces between the toe bones to figure out the location of the foot pain.

What tests will I need for a doctor to diagnose Morton’s neuroma?

Most of the time, your provider can diagnosis Morton’s neuroma based on your symptoms and a physical exam. An X-ray won’t show a neuroma. But it can help rule out other conditions that cause foot pain, such as a stress fracture or arthritis. You may also need an ultrasound or MRI to confirm the diagnosis.

Sometimes, your provider may recommend an electromyography procedure. This test measures the electrical activity of your nerves and muscles. It can rule out nerve conditions that can cause symptoms like those of Morton’s neuroma.

Management and Treatment

What are Morton’s neuroma treatments?

Treatment depends on the severity of the neuroma. There are several treatment options, from those you can do on your own to those done by a healthcare provider. You may need a combination of treatments to get the most relief.

Can I treat Morton’s neuroma at home?

These steps may improve your symptoms:

  • Wear good shoes: Choose supportive shoes with a wide toe box. Shoes with shock-absorbent soles and proper insoles can help. Don’t close the top of the shoe too tightly. And avoid shoes that are tight, have pointed-toes or have heels more than 2 inches high.
  • Use shoe pads: Put these over-the-counter pads into your shoe to relieve pressure.
  • Use an ice pack: Place an ice pack on your toes to reduce pain and swelling.
  • Rest: Try to rest and massage your feet. Avoid sports and other activities that put a lot of pressure on your foot.

What medications can help with Morton’s neuroma?

Your provider may recommend medications that can relieve pain and other symptoms.

Medications include:

  • Steroid injections.
  • Alcohol sclerosing injections, where a provider injects an alcohol solution to reduce nerve pain.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin, taken by mouth.
  • Anti-inflammatory drugs injected into the skin.
  • Local anesthetic injection to numb the nerve and relieve pain.

Can orthotics treat Morton’s neuroma?

Orthotics are custom shoe inserts that can reduce some of the pain of Morton’s neuroma. A healthcare provider adjusts orthotics to your foot shape. You wear them in your shoe to take the pressure off the painful nerve. Metatarsal pads in your shoe inserts and removable metatarsal pads can also offload the ball of your foot where you are having pain.

Will I need Morton’s neuroma surgery?

If medications and other treatments haven’t worked, your healthcare provider may recommend foot surgery. A neurectomy is the most common surgery for Morton’s neuroma. The surgeon removes part of the nerve tissue. Surgery can be a successful treatment for Morton’s neuroma. Some people have permanent numbness in the affected toe, though.

Surgeons may also recommend using extreme cold, either before the operation or as stand-alone treatment. This therapy, called cryogenic neuroablation, can help reduce symptoms. It destroys some nerve cells, as well as the myelin sheath covering the nerve. Treatment temperatures get as low as 94 degrees below zero Fahrenheit (70 degrees below zero Celsius).

Another minimally invasive procedure is radiofrequency ablation. This procedure uses an electric current to heat up your nerve tissue, helping with the pain. For most people, this procedure helps with pain relief — which can last anywhere from six to 12 months or longer.

Prevention

Can Morton’s neuroma be prevented?

You can take steps to prevent Morton’s neuroma:

  • Don’t wear tight or high-heeled shoes for long periods.
  • Wear shoes with a wide toe box, so your toes aren’t cramped.
  • When you’re more active, wear athletic shoes with plenty of padding to cushion the balls of your feet.
  • Maintain a healthy weight, since extra pounds put more pressure on your foot.
  • For athletes, talk to your coach or trainer to discuss tweaking activities for less pressure on the foot.

Outlook / Prognosis

What is the outlook for people with Morton’s neuroma?

Treatment is effective and can help you get back to living pain-free. Research has shown that a combination of treatments may give the best result:

  • Wearing roomy shoes.
  • Taking nonsteroidal anti-inflammatory medications.
  • Using custom orthotics.
  • Getting cortisone injections.

About 80% of people with Morton’s neuroma are successful using this combination approach.

Surgery is also an effective treatment for Morton’s neuroma. About 75% to 85% of people who have surgery find relief from their symptoms.

Can Morton’s neuroma come back after treatment?

Morton’s neuroma symptoms can come back. If you experience pain and symptoms after treatment, talk to your provider about next steps.

Living With

When should I see my healthcare provider?

See your healthcare provider (or a podiatrist, a foot specialist), if you have:

  • Severe pain that interferes with your daily activities.
  • Pain that continues to get worse or comes back.
  • Pain that doesn’t go away after two weeks of at-home treatment.
  • Tingling or numbness in your foot.
  • Diabetes, since people with diabetes are at higher risk for serious foot problems.

What questions should I ask my healthcare provider?

If you have Morton’s neuroma, ask your provider:

  • Can I treat this at home?
  • Will I need surgery?
  • What shoes will help my foot feel better?
  • Will the neuroma come back?
  • What medications can help?

A note from Cleveland Clinic

Morton’s neuroma is a treatable foot condition. Symptoms of Morton’s neuroma include pain in your toes. You may also feel like your socks have bunched up or that there’s a pebble under your foot. If you have pain, tingling or other uncomfortable foot symptoms, talk to your healthcare provider. Morton’s neuroma treatment includes steps you can take at home to relieve symptoms, such as rest and using shoe pads. Other treatments include medications, injections and, in severe cases, surgery. Treatment is often successful in returning you to your active life, pain-free.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy