What Is a Morton's Neuroma?
Morton's neuroma is a thickening of the tissue that surrounds the small nerve leading to the toes. It occurs as the nerve passes under the ligament connecting metatarsal bones in the forefoot (front part of the foot). It is not a "growth" in the foot, just an increase in size of the normal nerve tissue in the front part of the foot.
Morton's neuroma most frequently develops between the second/third and third/fourth toes. It often occurs in response to irritation, trauma, or excessive pressure, and is more common in women.
Morton's neuroma may feel like walking on a stone or marble. You may have burning pain in the ball of your foot that radiates into the toes. The pain can worsen with activity or wearing shoes, especially shoes that fit tightly around your toes. You may also experience numbness or a "clicking" feeling in the toes.
Runners may feel pain as they push off. High heeled and narrow toe box shoes also can aggravate the condition.
During the examination, your foot and ankle orthopaedic surgeon will feel for a mass or a "click" between the metatarsal bones. They will squeeze the spaces between the toes to try to recreate the pain. Range of motion tests are used to rule out arthritis or joint inflammation. Radiographs can help rule out a stress fracture or arthritis.
Initial treatment can involve several non-surgical options:
Changing shoes: Avoid high heels or tight shoes. Wear wider shoes with lower heels and a soft sole. This helps to decrease compression of the nerve.
Orthotics: Custom shoe inserts and pads may help relieve irritation by lifting and separating the bones, reducing the pressure on the nerve.
Injection: An injection of a corticosteroid will reduce the swelling and inflammation of the nerve, which should provide relief.
Several studies have shown that a combination of shoe changes, oral anti-inflammatory medications, orthotics, and/or cortisone injections will provide relief in more than 80% of people with Morton's neuroma. If conservative treatment does not relieve your symptoms, or if symptoms return, you may require surgery.
Surgery involves either removing a small portion of the nerve including the neuroma or releasing the tissue around the nerve to decompress it. It is an outpatient procedure, meaning the patient can go home the same day as surgery. Patients may be immobilized for 1-2 weeks to allow for healing of the incision, and then transitioned to regular shoes as tolerated.
Why do Morton's neuromas occur?
A neuroma is swelling of the nerve that travels to each side of your toe. It is not a growth or mass, but a normal structure that can become inflamed due to tight-fitting shoes, swelling, trauma, or other unknown causes.
If I do not have my Morton's neuroma treated, will it cause long-term damage?
No. Often, the swelling around the nerve will calm down with wearing wider shoes, a cortisone injection, or time.
Contributors/Reviewers: Patrick Maloney, MD; Jessica Kohring, MD
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