A neuroma is a painful swelling of a nerve, usually in the ball or heel of the foot. Symptoms include sporadic pain; burning, tingling or numbness of one or more toes; and a popping sensation when walking. It may feel as if there is a lump or a marble just beneath the ball of your foot. Pain is often soothed by taking weight off the foot or by massaging the area.
In the foot, there are the long bones (metatarsals) and thin nerves running between them. The nerves split in a Y-shape when they reach the toes. If the metatarsals move abnormally they can pinch the nerve between them which causes inflammation and eventually, permanent nerve damage. Morton’s neuroma is the most common of this type of nerve problem, affecting the nerve between the third and fourth toes. Neuromas may also occur after a nerve has been injured, either from a traumatic wound or from damage suffered during surgery.
Appearing more frequently in women than in men, Morton’s neuroma often causes cramping in the toes, tingling between the third and fourth toes and a burning pain in the ball of the foot that may radiate into the toes. The pain may be very regular or rarely occurring. However, as the condition worsens over time, episodes of pain will likely become more common and persistent.
The cause of Morton’s neuroma often remains undetermined. But there are certain factors that may influence the development and progression of this nerve problem. Some risk factors are:
- flat feet
- abnormal position of the toes
- forefoot issues such as hammer toes or bunions
- high arches
- wearing tight or ill-fitting shoes or high heels
- participation in certain high-impact sports such as running, which may subject the feet to trauma, and wearing tight shoes or boots for sports including skiing or rock climbing, which can create excessive pressure on the feet over time
Diagnosis of Morton’s Neuroma
Your doctor may be able to diagnose Morton’s neuroma upon a physical examination. The exam may include squeezing or pressing on the foot or toes in order to determine the source of the pain as well as whether any clicking sounds are heard. In addition, your doctor will most likely require one or more imaging tests, such as an X-ray, MRI or ultrasound, be performed to obtain a comprehensive view of the structures of the foot. This should provide enough information for your doctor to establish whether the pain is caused by Morton’s neuroma or by a condition with similar symptoms such as arthritis, stress fractures, tendon inflammation, tarsal tunnel syndrome and nerve compressions in the ankle or leg. In some cases, nerve testing may be performed to rule out some of these other conditions with similar symptoms.
Morton’s Neuroma Treatment
Treatment generally begins with a combination of cortisone injections to reduce swelling and orthotic inserts to correct problematic metatarsal movement. At home, you can improve the symptoms further by using an ice pack on the area in 10 to 15 minute intervals and resting your feet as often as possible. Take a break from any high-impact activities and massage the foot to relax the muscles near the toes as well. Other treatment options may include recommending a change in the patient’s footwear to roomier styles, taping the toes, padding the area, anti-inflammatory drugs taken orally, nerve blocking medications and physical therapy.
If conservative treatments do no relieve the symptoms, surgery may be required. One minimally invasive procedure sometimes used is cryogenic neuroablation. By exposing the nerve to freezing cold temperatures, this process can disrupt the transmission of pain signals from the nerve, but it is a temporary solution. Another option is decompression surgery, in which the force affecting the nerve can be removed by cutting a structure in the vicinity that is creating pressure. Often, it is a ligament that attaches several of the forefoot bones that is severed.
In some cases, the best relief will come from a procedure to remove thickened nerve tissues. If the nerve is permanently damaged, the patient may decide to undergo chemical destruction of the nerve or have the nerve surgically removed because the only other alternative is to endure the pain. These are highly successful techniques for the elimination of pain, but they can leave the patient with permanent numbness in the region, including the toes.