Morton's Neuroma

Morton's neuroma is a benign nerve tumor in the foot that causes pain.

Morton's neuroma is a condition in which a benign tumor grows in the nerve cells in the forefoot, causing irritation. It affects the nerve that passes under the toe bones (metatarsals) and most often occurs between the third and fourth toes.

Morton's neuroma frequently develops in response to irritation, trauma, or excessive pressure on the nerves in the forefoot.

Causes of Morton's neuroma include:

• Wearing shoes that are too tight in the toe area and compress the forefoot and toes
• Wearing high-heeled shoes that increase pressure on the forefoot and force the forefoot into a tight toe box. Morton's neuroma is 8 to 10 times more common in women than in men due to wearing high-heeled shoes.
• Repetitive impact to the forefoot, such as from exercises like running, or court and racket sports
• Risk factors for developing Morton's neuroma include having foot conditions such as:
• Bunions
• Hammer toes
• Flat feet
• Highly flexible feet

Morton's neuroma doesn’t have any visible outward signs such as a lump. Symptoms of Morton's neuroma include:

• Burning, shooting, or stabbing pain in the ball of the foot
• Feeling as if a small pebble is stuck under the forefoot
• Pain that may radiate to the toes
• Pain that worsens when wearing tight or high-heeled shoes or during certain activities that impact the forefoot
• Pain that may be worse when walking barefoot on hard surfaces
• Numbness, tingling, or discomfort in the toes

The pain from Morton's neuroma often worsens over time.

Morton's neuroma is diagnosed with a physical exam. A doctor will press on the forefoot to feel for a lump or irritation. Imaging tests may also be ordered to help diagnose Morton's neuroma.

Imaging tests may include:

• Ultrasound
• Magnetic resonance imaging (MRI)
• X-rays can help rule out other causes such as stress fractures

It is important for a doctor to rule out fractures, arthritis, cancer, osteoporosis, or other conditions that may be the cause of the foot pain in order to receive proper treatment.

The first line treatment for Morton's neuroma usually involves home remedies to ease the pressure and irritation on the foot.

Home remedies to relieve the acute pain of Morton's neuroma include:

• Resting the foot
• Keeping the foot elevated
• Applying ice to the foot for 20 minutes every few hours
• Taking over-the-counter (OTC) pain medications such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol)
• Home remedies that may help reduce and prevent pain of Morton's neuroma include:
• Wearing shoes with a wide toe box
• Wearing shoes with low heels
• Wearing comfortable shoes with a soft sole
• Using cushioned insoles
• Losing weight if you are overweight
• Massage. (Avoid deep tissue massage in this area. It is best to find a practitioner experienced in treating Morton's neuroma to avoid aggravating the nerves.)

If home remedies do not relieve Morton's neuroma, there are medical treatments that can help.

• Prescription custom orthotics – help relieve pressure and irritation of the nerve
• Corticosteroid injections – reduce inflammation and swelling
• Physical therapy exercises may be prescribed to help stretch the forefoot and strengthen the surrounding foot muscles

Home remedies combined with orthotics and/or steroid injections will relieve pain in about 80% of cases. In severe cases surgery may be needed. The 2 common procedures to treat Morton's neuroma are:

• Decompression surgery is the most common approach, whereby a doctor will cut a nearby ligament to help take pressure off the nerve
• Removal of the affected nerve takes away the damaged tissue and usually removes the source of the pain

Morton's neuroma can be prevented by wearing properly-fitted cushioned shoes that have plenty of room in the toe box.

Avoid high-heeled, tight, or pointy shoes.

The prognosis for Morton's neuroma depends on the condition of the foot at the time of diagnosis and whether home treatments are effective. The earlier the condition is treated, the better the chances are of recovery.

In patients who require surgery, the prognosis varies and there may be some residual complications. Post-operative surgical pain is common, and recovery can take 3 to 4 months. Up to one-third of surgical patients have post-surgical pain that is more difficult to treat than the initial Morton’s neuroma foot pain. Post-operative foot instability is another complication that may occur.