Morton's Neuroma

A benign condition in which a nerve going to the toes becomes thickened and irritated in the forefoot, causing burning and pain.

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1Overview

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What is this Condition?

Morton's neuroma is a thickening of a nerve that passes between the metatarsal bones in the forefoot due to prolonged compression and irritation. Despite its name 'neuroma,' it is not a true tumor; a callus-like thickening develops around the nerve. It occurs most frequently between the third and fourth toes and is significantly more common in women than men. The typical symptom is burning, throbbing, or electric shock-like pain in the ball of the foot. Pain increases when wearing tight or high-heeled shoes or after prolonged walking; removing the shoe and rubbing the foot provides relief to most patients. When detected early and appropriate measures are taken, the course is generally favorable.

Symptoms

Burning, throbbing, or electric shock-like pain in the ball of the foot, between the toes

Pain worsening with tight or high-heeled shoes or prolonged walking

Relief when removing the shoe and massaging the foot (very typical finding)

Numbness and tingling in the affected toes

Sensation of a crumpled sock or small stone under the foot inside the shoe

Avoidance of prolonged standing or walking, limping

Diagnosis Methods

Diagnosis is usually made by physical examination. The physician compresses the forefoot from the sides while pressing between the toe spaces; the 'click' felt at this moment and reproduction of pain (Mulder test) is highly suggestive of Morton's neuroma. Ultrasound or MRI is used to support the diagnosis and visualize the size of the thickened nerve. Sometimes a diagnostic injection of local anesthetic into the area confirms the diagnosis by demonstrating pain relief. X-ray does not show the nerve itself but helps exclude other bone-related problems.

Treatment Methods

Treatment almost always starts with simple measures and is sufficient in many patients. The most important step is switching to wide-toed, flat, soft-soled shoes; avoiding high heels and tight shoes. A small support placed behind the metatarsal heads (metatarsal pad) reduces pressure on the nerve. Physical therapy and pain-relieving medications may provide support. If adequate relief does not occur, an anti-inflammatory (corticosteroid) injection can be administered to the area. For patients who do not respond to these measures and continue to have pain, surgical options such as nerve removal or decompression by releasing surrounding ligaments are considered.

Switching to wide-toed, flat, soft-soled shoes; avoiding high heels and tight shoes

Support behind the metatarsal heads (metatarsal pad) and custom orthotics

Anti-inflammatory (corticosteroid) injection to the area

Surgery in patients with inadequate response: nerve removal or decompression by releasing surrounding ligaments

References

Waldman SD. Atlas of Common Pain Syndromes. 3. baskı. Philadelphia: Saunders/Elsevier; 2012:372-373.
Waldman SD. Atlas of Pain Management Injection Techniques. Philadelphia: Elsevier; 2017:670-671.
Waldman SD. Atlas of Common Pain Syndromes. 2. baskı. Philadelphia: Saunders/Elsevier; 2011:372-373.

This content is based on academic sources and is for general information only; individual assessment requires a medical examination.

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Morton's Neuroma

Peripheral Nerve Surgery

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

References

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