What is Morton’s neuroma?

How do you get Morton’s neuroma and how do you get rid of it?

Morton’s neuroma is a painful condition that involves the thickening of a nerve in between the metatarsal bones in the balls of the feet. Morton’s neuroma is benign, however, it can worsen, increasing in size and causing significant pain and discomfort. It is commonly found in the 2nd or 3rd interspaces, however, it can occur in other areas of the feet as well and the majority of people that have this condition are women. 

People who have Morton’s neuroma often experience pain in between their toes when walking. Symptoms can include tingling, burning or numbness, or the feeling of a stone in your shoe. Read on to learn about this condition, what causes it and how we can treat it.

what is a morton's neuroma?

Morton’s neuroma is a distinct condition that affects the nerve in the interspaces in the foot, named after Thomas George Morton in 1876. It commonly occurs in the second and third interspaces, however it can also occur in other interspaces. Due to its location, it is sometimes referred to as intermetatarsal neuroma.

Morton’s neuroma is sort of like having a benign tumour of the nerve, but it isn’t technically a tumour. Rather, it is a tissue surrounding the digital nerve leading to the toes that thickens over time causing nerve entrapment. Once thickened, the nerve can create further trauma that results in its additional thickening and subsequently more nerve entrapment.

Mortons neuroma image

signs and symptoms of morton's neuroma

The most common symptoms of Morton’s neuroma are the following:

  • Aching or burning sensation between toes
  • Burning or shooting pain in the ball of the foot radiating to the toes
  • Discomfort like having a stone inside your shoe
  • Tingling and pricking sensation on the toes
  • Discomfort when walking or wearing constrictive shoes
  • Pain that usually resolves with rest and not wearing shoes

if it is not morton's neuroma, what is it?

If you are experiencing similar symptoms, it could also be:

  • Tarsal tunnel syndrome
  • Peripheral neuropathy
  • Metatarsalgia
  • Callous
  • Stress fracture
  • Bursitis
  • Joint Synovitis
  • Fibromyalgia
  • Infection

what causes morton's neuroma?

The exact cause of Morton’s neuroma is still unknown, but the following factors are linked to its development:

  • Biomechanical factors: Foot posture such as flat feet or high arches can cause excess loading on the toe joints and thus lead to repeated stress on the nerve.
  • Tight calf muscles: Limited ankle movement can cause increased loading on the balls of the feet.
  • Footwear: Narrow/tight fitting shoes with high heels can compress the nerves and increase pressure on the balls of the feet.
  • Trauma: Physical injury from falling or a blow can contribute to Morton’s neuroma.
  • Repeated stress: Exercise or occupations that cause increased pressure on the front of the foot can also lead to the development of Morton’s neuroma.
high heels causing morton's neuroma

podiatrist assessment

morton-neuroma-5

Case courtesy of Dr Maxime St-Aman  From case 20132

We recommend seeing a podiatrist at the first sign of symptoms. Neuromas can worsen if left untreated. Assessment includes a medical history and physical examination. There are tests that your podiatrist can use to diagnosis Morton’s neuroma in the clinic. In some cases, your podiatrist may send for an ultrasound for additional assessment. Correct diagnosis is important as there are other conditions that can cause pain in the same area of the foot.

treatment for morton's neuroma

Treatment for Morton’s neuroma is initially conservative but it can progress to operative if symptoms do not resolve with conservative measures. After your assessment, your podiatrist will recommend treatment based on your preferences and the severity of your symptoms.

conservative treatment

The goal of conservative treatment for Morton’s neuroma is to reduce symptoms and discomfort when walking. Conservative treatment is unable to reverse damage to the nerve and is more successful in neuroma in its early stages of development.

Conservative treatment can consist of the following:

  • Anti-inflammatory medication
  • Icing
  • Rest
  • Changes to footwear: Avoid wearing tight-fitting shoes that could cause further compression on the nerve. Consider wider toes and lower heels (less than 4cm), as this can help reduce compression on the nerve. Footwear with thick soles can also reduce shock and pressure on the feet.
  • Heel lifts
  • Padding and taping: Adding padding or taping the ball of the foot can help reduce pressure on the neuroma and thus reduce symptoms.
  • Stretching: Loosening tight calf muscles can help reduce any extra pressure on Morton’s neuroma and ultimately reduce symptoms.
  • Physiotherapy
  • Injection therapy: Cortisone injections or alcohol injections have shown success in managing Morton’s neuroma.
  • Orthotic therapy: A modified custom orthotic with a metatarsal dome can help separate the bones in the foot and reduce pressure and trauma on the affected nerve.

surgery

Current clinical guidelines recommend conservative treatment for 3-6 months before considering surgery. However, in some cases symptoms may be severe and your podiatrist will recommend treatment accordingly.

Surgery for Morton’s neuroma is performed by a podiatric surgeon or an orthopaedic surgeon and consists of excising the affected nerve.

Surgery is the only definitive way to get rid of Morton’s neuroma. This procedure is performed at the hospital during the day and takes around 20 minutes. Following surgery, patients can begin to put weight on their operated foot straight away, but they will have to wear a splinted sandal for up to 2-6 weeks. Morton’s neuroma surgery is successful in most patients, but like any procedure, it does have risks. 

If needed your podiatrist can refer you for surgical assessment where your surgeon can thoroughly describe the procedures involved and the results you can expect.

Figure 2. Singh SK, et. al. The surgical treatment of Morton’s neuroma. J Curr Ortho. 2005

how to prevent morton's neuroma

Here are a few things you can do to prevent Morton’s neuroma:

  • Wear shoes with wide toes to avoid cramming your toes at the front
  • Wear shoes with enough padding or cushioning at the ball of the feet
  • Reduce time when wearing tight or extremely high heeled shoes
  • Wear orthotics for cushioning and support for prevention of foot pain
  • See a podiatrist at the first signs of symptoms and discomfort

faq

Tight calf muscles are a risk factor for developing Morton’s neuroma. Massage therapy for your calf muscles may help improve your range of motion and ultimately take pressure off the balls of your feet.

Morton’s neuroma has a high success rate however in some rare cases it can reoccur. This is usually due to poor diagnosis.

Once the nerve has fibrosed and thickened, it cannot be reversed and is therefore permanent. Symptoms however can resolve if managed correctly.

No, but treatment can help resolve symptoms. Surgical excision is the only way to remove a neuroma.

Though there is no correlation between the size of Morton’s neuroma and symptoms, the average size of is between 4mm-6mm.

Orthotics with specific modifications for Morton’s neuroma can help reduce symptoms.

Thin soled shoes can cause excess pressure on the balls of the feet however there have been no studies to support that flip flops directly contribute to the development of Morton’s Neuroma.

Yes, excising the affected nerve is an effective treatment.

Treating Morton’s neuroma may require a multi-disciplinary approach. Your doctors can include the following: podiatrist, GP, podiatric surgeon/orthopaedic surgeon, radiologist, physiotherapist.

Narrow, high heeled shoes, activities with high impact on the balls of your feet, thin soled shoes or increased barefoot activities, or tight calf muscles.

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