Mortons neuroma is a painful condition caused by an irritated nerve in the ball of your foot. It causes a stinging, burning or shooting pain in the ball of your foot or in the spaces between the third and fourth toes. The pain may also cause a pins and needles feeling or numbness.
Symptoms
When Morton’s neuroma develops, the affected nerve becomes thickened and swollen, and this can cause pain, tingling, or a feeling like you are stepping on a marble. You may also notice a burning sensation in the ball of your foot. Symptoms of this condition usually begin gradually and get worse over time. They tend to occur when you wear shoes with narrow toe boxes or engage in activities that put pressure on the feet, such as walking or playing sports.
Your healthcare provider will diagnose the problem by performing a physical exam of your feet. They will gently squeeze your forefoot and toes to check for tenderness. They will also ask you when the symptoms started and what activities make them worse. A foot X-ray won’t show a neuroma, but it can help rule out other problems that cause similar symptoms.
The exact cause of Morton neuroma isn’t known, but it may be caused by pressure or irritation on the nerve. This can happen when you wear tight shoes with a small toe box, especially high heels. Having certain foot deformities, such as bunions or hammertoes, can also increase your risk of developing this condition.
If you experience the symptoms of this condition, visit your healthcare provider right away. They can diagnose the issue and recommend treatments that will relieve your symptoms and prevent the neuroma from getting worse. Your treatment plan may include footwear changes, such as switching to shoes with wide toe boxes or using padding or shoe stretchers. They may also prescribe medications, such as anti-inflammatory or steroid medications. If the pain persists, they might suggest steroid injections or surgery. The sooner you receive care, the less likely you are to have long-term complications from Morton’s neuroma, such as chronic pain in the ball of your foot or permanent nerve damage.
Diagnosis
A Morton neuroma is an enlarged nerve in the ball of the foot, which is the padded area between the toes and arch. This condition causes pain, a feeling of pins and needles, or numbness in the two toes closest to the affected nerve. The exact cause is unknown, but pressure on the nerve from shoes or from activities that force your feet into a position where they are bunched up can contribute to the damage and enlargement of the nerve.
The first symptom of Morton neuroma is usually sharp pain that comes and goes in the ball of your foot, typically around the third and fourth toes. This pain is worse when you wear tight or high-heeled shoes and gets progressively worse over time. Other symptoms may include a burning sensation in the ball of your foot, a click when you squeeze your foot, or an inability to walk for long periods of time without experiencing pain or numbness in your toes.
To diagnose Morton neuroma, your doctor will perform a physical exam of your foot. He or she will press on the bottom of your foot in the areas where you experience pain to see if it reproduces. Your doctor will also check for a clicking sensation in the ball of your foot called Mulder’s click, which is associated with this condition.
An MRI or ultrasound is used to confirm the diagnosis in some cases. This type of imaging can help your doctor find the location of the neuroma and spot any other problems in your foot.
Your provider may recommend surgery if nonsurgical treatment is not successful or if you cannot walk without extreme pain or numbness in your toes. The most common surgery for a Morton neuroma is a neurectomy, which involves cutting or removing the tissue that surrounds the nerve. Another option is cryogenic neuroablation, which uses extreme cold to destroy a small portion of the nerve and reduce your symptoms. However, even with surgery, you may still have numbness in your toes. This is because the neuroma can return once the inflamed tissues are gone.
Treatment
Morton neuroma is a damaged, enlarged nerve in the bottom of the forefoot (the area between the arches and toes on the bottom of the foot). The pain may feel like a burning or sharp pain in the ball of the foot. It can also cause tingling and numbness in the toes. It occurs when pressure is placed on the nerve for too long, usually from tight or high-heeled shoes. People with certain foot conditions such as bunions, hammertoes and flat feet are at a higher risk of developing this condition.
Your provider will diagnose the condition by examining your feet. They will put pressure on the spaces between your toes and might hear or feel a click that’s sometimes present with a Morton neuroma (Mulder’s click). A foot X-ray can help confirm the diagnosis. An ultrasound can also be used to see the nerve and surrounding tissue. MRI may be needed in rare cases to get more detailed images of the nerve and surrounding tissues.
Treatment options vary depending on how long you’ve had the condition and its severity. The goal of nonsurgical treatments is to reduce the amount of compression on the affected nerve and to relieve pain and numbness.
Nonsurgical treatments include footwear modifications, shoe inserts and ice therapy. Changing to shoes with wider toe boxes and lower heels will help reduce pressure on the affected nerve. Wearing soft insoles or custom orthotics may also help relieve symptoms. Medications such as ibuprofen can decrease pain and inflammation.
If the pain gets worse, your provider may suggest steroid injections. These injections can numb the affected nerve, reduce inflammation and possibly shrink the neuroma.
Other treatment options include physical therapy and extracorporeal shockwave therapy (ESWT). Physical therapies are speculated to decrease pain by reducing plantar forefoot pressure and web space compression, while ESWT suppresses nociceptive nerve fibres and results in pain reduction (Seok 2016). In some cases, surgery is recommended to remove the thickened nerve tissue. However, the numbness that follows the surgery is permanent. For this reason, it’s important to seek treatment early.
Prevention
Morton’s neuroma is a condition that develops when the nerve tissue between your third and fourth toes becomes thickened due to pressure and irritation. This condition is characterized by pain, numbness, and the sensation of a pebble under the foot when walking or standing. Fortunately, this condition can be prevented through footwear modifications and the use of orthotic devices.
The human foot is a complex structure composed of numerous bones, ligaments, muscles, and nerves. The interdigital nerve, which runs through the forefoot between the metatarsal bones, is most commonly affected by Morton’s neuroma. The condition causes painful, burning sensations in the area between the toes and is often accompanied by numbness or tingling.
This foot condition tends to affect middle-aged individuals and is more common in women than men. However, it can also occur in athletes who regularly engage in activities that place excessive pressure on the feet. The risk of developing this foot condition may also increase if you have other foot problems, such as bunions or hammertoes, flat feet, high arches, or overpronation. In these cases, a podiatrist can recommend treatment strategies that address the root cause of your foot issues to help prevent the development of a neuroma.
Wearing Shoes with a Wide Toe Box
Modifying your footwear can significantly reduce the chance of developing a neuroma. Choosing shoes with a wide toe box and low heels can help relieve the pressure placed on the foot by the forefoot bones. In addition, utilizing orthotic shoe inserts such as metatarsal pads or bars can redistribute the weight of the foot and reduce pressure on the forefoot.
Changing your diet can also greatly reduce the risk of developing this foot condition. Embracing a healthy diet that is rich in Omega-3 fatty acids, antioxidants, and adequate hydration can help to control inflammation and improve overall foot health. Avoiding sugary drinks and snacks, processed foods, and excess alcohol can also significantly contribute to symptom control.
In addition to dietary changes, many people can also improve their symptoms by performing simple exercises at home. For example, placing a towel on the floor and scrunching it with your toes can improve foot bio-mechanics and reduce stress on the nerve.