Morton's neuroma is a benign but painful condition that affects the ball of the foot. It’s also called an intermetatarsal neuroma because it’s located in the ball of the foot between your metatarsal bones.
It happens when the tissue around a nerve that leads to a toe thickens from irritation or compression. It most often occurs between the third and fourth toes, but can also occur between the second and third toes. It most commonly occurs in middle-aged people, especially middle-aged women.
What are the symptoms?
Pain, often intermittent, is the main symptom of Morton's neuroma. It may feel like a burning pain in the ball or your foot or like you’re standing on a marble or pebble in your shoe or a bunched-up sock.
Your toes may feel numb or tingle as the pain radiates out. You may have difficulty walking normally because of the pain. You won’t have any noticeable swelling on your foot, though.
Sometimes you may have Morton's neuroma without any symptoms. A small study from 2000 reviewed medical records from 85 people who had their feet imaged with magnetic resonance imaging (MRI). The study found that 33 percent of the participants had Morton's neuroma but no pain.
What causes Morton's neuroma?
Morton’s neuroma is often caused by shoes that are too tight or that have high heels. These shoes can cause the nerves in your feet to become compressed or irritated. The irritated nerve thickens and gradually becomes more painful as a result of the pressure on it.
Another possible cause is a foot or gait abnormality, which can lead to instability and can also put pressure on a nerve in your foot.
Morton's neuroma is often associated with:
It’s also associated with activities such as:
- repetitive sports activities, such as running or racquet sports, that increase pressure on the ball of the foot
- sports that require tight shoes, such as skiing or ballet
Sometimes, a neuroma results from injury to the foot.
When should you see a doctor?
If you have foot pain that doesn't go away even after changing your footwear or stopping activities that might be responsible, see your doctor. Morton's neuroma is treatable, but if it’s not treated promptly it can lead to permanent nerve damage.
Your doctor will ask you how the pain started and physically examine your foot. They’ll put pressure on the ball of your foot and move your toes to see where you have pain. A doctor will usually be able to diagnose Morton's neuroma just from a physical examination and by discussing your symptoms.
To rule out other possible causes of your pain, such as arthritis or a stress fracture, your doctor may sometimes order imaging tests. These can include:
- X-rays to rule out arthritis or fractures
- ultrasound images to identify abnormalities in soft tissue
- an MRI to identify soft tissue abnormalities
If your doctor suspects another nerve condition, they may also perform an electromyography. This test measures the electrical activity produced by your muscles, which can help your doctor better understand how well your nerves are functioning.
How is Morton's neuroma
Treatment depends on the severity of your symptoms. Your doctor will usually use a graduated plan. That means you’ll start with conservative treatment and move on to more aggressive treatments if your pain persists.
Conservative and home treatments
Conservative treatment starts with using arch supports or foot pads for your shoes. These help relieve the pressure on the affected nerve. They can be over-the-counter (OTC) inserts or custom made by prescription to fit your foot. Your doctor may also suggest OTC pain killers or nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin) or aspirin.
Other conservative treatments include:
- physical therapy
- stretching exercises to loosen tendons and ligaments
- massaging the ball of your foot
- exercises to strengthen your ankles and toes
- resting your foot
- applying ice to sore areas
If your pain persists, your doctor may try injections of corticosteroids or anti-inflammatory drugs into the area of pain. A local anesthetic injection may also be used to numb the affected nerve. That may help relieve your pain temporarily.
Alcohol sclerosing injections are another remedy that may provide short-term pain relief. A long-term study found that only 29 percent of people who had alcohol injections remained symptom-free, however.
When other treatments have failed to provide relief, your doctor may suggest surgery. Surgical options may include:
- neurectomy, where part of the nerve tissue is removed
- cryogenic surgery, also known as cryogenic neuroablation, where nerves and the myelin sheath covering them are killed using extremely cold temperatures
- decompression surgery, where pressure on the nerve is relieved by cutting ligaments and other structures around the nerve
What can you expect?
Your recovery time will depend on the severity of your Morton's neuroma and the type of treatment you receive. For some people, a change to wider shoes or shoe inserts gives quick relief. Others may require injections and painkillers to get relief over time.
Surgical recovery time varies. The recovery from nerve decompression surgery is quick. You will be able to bear weight on the foot and use a padded shoe right after surgery.
Recovery is longer for a neurectomy, ranging from 1 to 6 weeks, depending on where the surgical cut is made. If the incision is at the bottom of your foot, you may need to be on crutches for three weeks and have a longer recovery time. If the incision is on the top of the foot, you can put weight on your foot right away while wearing a special boot.
In both cases, you'll have to limit your activities and sit with your foot elevated above your heart level as often as you can. You'll also have to keep the foot dry until the incision heals. Your doctor will change the surgical dressing in 10 to 14 days. How soon afterward you can go back to work will depend on how much your job requires you to be on your feet.
In a small number of cases, Morton's neuroma may recur after the initial treatment.
What’s the outlook?
Conservative treatment brings people with Morton’s neuroma relief 80 percent of the time. There are few long-term studies of surgical treatment results, but the Cleveland Clinic reports that surgery effectively relieves or reduces symptoms in 75 to 85 percent of cases.
Statistics comparing the results of different treatments are limited. A small 2011 study found that 41 percent of people who changed their footwear required no further treatment. Of the people who received injections, 47 percent saw improvement and didn’t need further treatment. For people who needed surgery, 96 percent improved.
What can you do to prevent
One of the easiest ways to prevent recurrence of Morton's neuroma is to wear the right kind of shoes.
- Avoid wearing tight shoes or shoes with high heels for long periods of time.
- Choose shoes that have a wide toe box with plenty of room to wiggle your toes.
- If the doctor recommends it, wear an orthotic insert to take pressure off the ball of your foot.
- Wear padded socks, which can help protect your feet if you stand or walk a lot.
- If you participate in athletics, wear footwear that is padded to protect your feet.
- If you stand for long periods of time in the kitchen, at a cash register, or at a standing desk, get an antifatigue mat. These cushioned mats can help provide relief to your feet.
You may also want to see a physical therapist for a routine of stretches and exercises to strengthen your legs and ankles.