Morton's neuroma

Overview

Morton's neuroma is a painful condition that affects the ball of your foot, most commonly the area between your third and fourth toes. Morton's neuroma may feel as if you are standing on a pebble in your shoe or on a fold in your sock.

Morton's neuroma involves a thickening of the tissue around one of the nerves leading to your toes. This can cause a sharp, burning pain in the ball of your foot. You may have stinging, burning or numbness in the affected toes.

High-heeled or tight shoes have been linked to the development of Morton's neuroma. Many people experience relief by switching to lower heeled shoes with wider toe boxes. Sometimes corticosteroid injections or surgery may be necessary.

Symptoms

Typically, there's no outward sign of this condition, such as a lump. Instead, you may experience the following symptoms:

• A feeling as if you're standing on a pebble in your shoe
• A burning pain in the ball of your foot that may radiate into your toes
• Tingling or numbness in your toes

In addition to these symptoms, you may find that removing your shoe and rubbing your foot often helps to relieve the pain.

When to see a doctor

It's best not to ignore any foot pain that lasts longer than a few days. See your doctor if you experience a burning pain in the ball of your foot that's not improving, despite changing your footwear and modifying activities that may cause stress to your foot.

Causes

Morton's neuroma seems to occur in response to irritation, pressure or injury to one of the nerves that lead to your toes.

Risk factors

Factors that appear to contribute to Morton's neuroma include:

• High heels. Wearing high-heeled shoes or shoes that are tight or ill fitting can place extra pressure on your toes and the ball of your foot.
• Certain sports. Participating in high-impact athletic activities such as jogging or running may subject your feet to repetitive trauma. Sports that feature tight shoes, such as snow skiing or rock climbing, can put pressure on your toes.
• Foot deformities. People who have bunions, hammertoes, high arches or flatfeet are at higher risk of developing Morton's neuroma.

Diagnosis

During the exam, your doctor will press on your foot to feel for a mass or tender spot. There may also be a feeling of "clicking" between the bones of your foot.

Imaging tests

Some imaging tests are more useful than others in the diagnosis of Morton's neuroma:

• X-rays. Your doctor is likely to order X-rays of your foot to rule out other causes of your pain — such as a stress fracture.
• Ultrasound. This technology uses sound waves to create real-time images of internal structures. Ultrasound is particularly good at revealing soft tissue abnormalities, such as neuromas.
• Magnetic resonance imaging (MRI). Using radio waves and a strong magnetic field, an MRI also is good at visualizing soft tissues. But it's an expensive test and often indicates neuromas in people who have no symptoms.

Treatment

Treatment depends on the severity of your symptoms. Your doctor will likely recommend trying conservative approaches first.

Therapy

Wear shoes with adequate room across the ball of the foot and in the toe. Arch supports and foot pads such as metatarsal pads fit inside your shoe and help reduce pressure on the nerve. These can be purchased over the counter, or your doctor may prescribe a custom-made, individually designed shoe insert — molded to fit the exact contours of your foot.

Surgical and other procedures

If conservative treatments haven't helped, your doctor might suggest:

• Injections. Some people are helped by the injection of steroids into the painful area.
• Decompression surgery. In some cases, surgeons can relieve the pressure on the nerve by cutting nearby structures, such as the ligament that binds together some of the bones in the front of the foot.
• Removal of the nerve. Surgical removal of the growth may be necessary if other treatments fail to provide pain relief. Although surgery is usually successful, the procedure can result in permanent numbness in the affected toes.

Lifestyle and home remedies

To help relieve the pain associated with Morton's neuroma and allow the nerve to heal, consider the following self-care tips:

• Take anti-inflammatory medications. Over-the-counter nonsteroidal anti-inflammatory medications, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), can reduce swelling and relieve pain.
• Try ice massage. Regular ice massage may help reduce pain. Freeze a water-filled paper cup or plastic foam cup and roll the ice over the painful site.
• Change your footwear. Avoid high heels or tight shoes. Choose shoes with a broad toe box and extra depth.
• Take a break. For a few weeks, reduce activities such as jogging, aerobic exercise or dancing that subject your feet to high impact.

Preparing for an appointment

You might first seek advice from your family doctor about your foot pain. He or she may refer you to a doctor or surgeon who specializes in foot disorders. Before your appointment, you may want to write a list of answers to the following questions:

• When did your symptoms begin?
• Did your symptoms begin gradually or suddenly?
• What type of footwear do you wear for work?
• Do you participate in sports? If so, what types in particular?
• What medications and supplements do you take regularly?

What to expect from your doctor

Your doctor may ask some of the following questions:

• Is the pain worse in certain pairs of shoes?
• Does any type of activity ease the pain or worsen it?
• Are you having pain in any other part of your body?