Morton's neuroma

Did You Know: Morton's neuroma is an injury to the nerve between the toes, which causes thickening and pain. It commonly affects the nerve that travels between the third and fourth toes.

Causes, incidence, and risk factors

Morton's neuroma is more common in women than in men.

The exact cause is unknown. However, some experts believe the following may play a role in the development of this condition:

Abnormal positioning of toes

Flat feet

Forefoot problems, including bunions and hammer toes

High foot arches

Tight shoes and high heels

Symptoms

Symptoms of Morton's neuroma include:

Tingling in the space between the third and fourth toes

Toe cramping

Sharp, shooting, or burning pains in the ball of your foot (and sometimes toes)

Pain that increases when wearing shoes or pressing on the area

Pain that gets worse over time

In rare cases, nerve pain occurs in the space between the second and third toes. This is not a common form of Morton's neuroma, but treatment is similar.

Signs and tests

Your health care provider can usually diagnose this problem by examining your foot. A foot x-ray may be done to rule out bone problems. MRI or high-resolution ultrasound can successfully diagnose Morton's neuroma.

Nerve testing (electromyography) cannot diagnose Morton's neuroma, but may be used to rule out conditions that cause similar symptoms.

Blood tests may be done to check for inflammation-related conditions, including certain forms of arthritis.

Treatment

Nonsurgical treatment is tried first. Your doctor may recommend any of the following:

Padding and taping the toe area

Shoe inserts

Changes to footwear (for example, shoes with wider toe boxes)

Anti-inflammatory medicines taken by mouth or injected into the toe area

Nerve blocking medicines injected into the toe area

Other painkillers

Physical therapy

Anti-inflammatories and painkillers are not recommended for long-term treatment.

In some cases, surgery may be needed to remove the thickened tissue. This can help relieve pain and improve foot function. Numbness after surgery is permanent, but should not be painful.

Expectations (prognosis)

Nonsurgical treatment does not always improve symptoms. Surgery to remove the thickened tissue is successful in about 85% of cases.

Complications

Morton's neuroma can make walking difficult. Persons with this foot condition may also have trouble performing activities that put pressure on the foot, such as pressing the gas pedal of an automobile. It may hurt to wear certain types of shoes, such as high-heels.

Calling your health care provider

Call your health care provider if you have persistent pain or tingling in your foot or toe area.

Prevention

Avoid ill-fitting shoes. Wear shoes with a wide toe box.

References

McGee DL. Podiatric procedures. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 51.
Davies AM, Grainger AJ. Techniques and imaging of soft tissues. In: Adam A, Dixon AK, eds. Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging. 5th ed. New York, NY: Churchill Livingstone; 2008:chap 45.

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