Understanding and Treating Morton's Neuroma:
Symptoms, Causes, and Effective Solutions
Morton's neuroma is a painful condition that affects the ball of the foot, usually between the third and fourth toes. If you've been experiencing sharp, burning pain, tingling, or numbness in that area, you may have Morton's neuroma. In this patient guide, we'll walk you through the symptoms, explain what causes this condition, and discuss both conservative pain management treatments and surgical options to relieve neuroma pain. With an understanding of what's happening and the available treatments, you can work with your doctor to find the right solution for lasting relief.
What is Morton’s Neuroma?
Morton's neuroma is a condition that affects one of the nerves between the toes, usually between the third and fourth toes. It causes thickening of the tissue around the nerve, which leads to pain, tingling, burning, and numbness in the ball of the foot. Morton's neuroma often occurs as a result of irritation, pressure, or injury to the nerve. Things that can contribute to the development of a neuroma include wearing high heels or shoes with a narrow toe box, having a high arch that puts pressure on the ball of the foot, or repeated stress to the foot from certain sports or occupations. The symptoms of Morton’s neuroma can range from mild discomfort to severe pain that impedes walking. This could feel like a burning pain in the ball of the foot, tingling or numbness between the toes or in the larger toes, or the feeling that there is a mass or lump on the bottom of the foot.
Morton's neuroma often worsens over time if left untreated. While not all cases require surgery, treatment options range from padding and orthotics to relieve pressure on the foot to steroid injections or ultrasound therapy to reduce inflammation of the nerve. For severe or persistent cases, surgery can be done to remove the inflamed nerve tissue to provide lasting relief. Catching and treating Morton’s neuroma early on can help manage symptoms before they become too debilitating.
Symptoms of Morton’s Neuroma
The painful symptoms of Morton’s Neuroma may be triggered or aggravated by things like wearing high heels, tight shoes, standing for long periods, or repetitive foot trauma. Common symptoms include:
- Burning, sharp pain in the ball of the foot, usually located between the third and fourth toes.
- Tingling or numbness in the third and fourth toes.
- A feeling like there is a pebble or fold in your sock rubbing on your foot when walking.
- A sensation similar to stepping painfully on a small object.
- Pain that radiates out to the adjacent toes.
- Pain and discomfort that worsens over time with repeated irritation.
- An electric shock or burning sensation that runs from the ball of the foot to the toes.
- Sensations of numbness, pins-and-needles, or hypersensitivity to touch in the toes.
- The feeling of having a bunched-up sock or a fold under the ball of the foot.
What Does Morton’s Neuroma Pain Feel Like?
In the early stages of Morton’s neuroma, symptoms may only occur after certain activities that irritate or compress the nerve, such as restricting shoes, engaging in high-impact exercises, or walking long distances. The pain starts gradually with a tingling, burning, numbness, or stinging feeling typically between the third and fourth toes. Over time, this intermittent irritation progresses into more persistent pain and inflammation of the nerve tissue. As the condition worsens with repeated trauma, the pain intensifies to a sharp, electric, or searing pain that radiates outwards towards the adjacent toes. Even light touch from socks or bedsheets can become unbearably painful. Eventually, it may become extremely painful to walk even short distances. Left untreated over months to years, the inflamed nerve becomes so thickened and hypersensitive that even standing still leads to debilitating burning, shock-like, or pinching pain in the ball of the foot and between the toes. This leads to an altered gait as the person instinctually avoids applying pressure to the painful area of the foot while walking. Although less common than other causes of foot pain like capsulitis or plantar fasciitis, untreated Morton’s neuroma can become just as disabling in severe cases without proper intervention.
Causes of Morton’s Neuroma
The common thread in the development of Morton's neuroma is repeated irritation, compression, or injury to the nerve tissue between the bones that make up the ball of the foot, leading it to become inflamed and scarred over time. Prevention involves avoiding culprit shoes, inserts to normalize foot pressure, and early diagnosis and treatment.
Wearing shoes with a narrow toe box or high heels:
These types of shoes can compress the forefoot and irritate the nerve tissue between the toes. The repeated irritation and pressure on the nerve can cause inflammation and thickening over time.
High foot arches or metatarsal pressure:
Those with high arches are prone to developing Morton’s neuroma as more pressure is placed on the ball/forefoot, which can compress the nerve.
Injury or trauma to the foot:
Injuries like bone fractures, sprains, or prior foot surgery can lead to scar tissue formation and inflammation that compresses the nerve.
Certain activities and sports:
Sports that involve repetitive irritation or stress on the ball of the foot, such as running, basketball, ballet, or aerobics, can cause neuroma.
Abnormal foot mechanics and pronation issues:
Flat feet, high arches, and excessive foot pronation (carrying your weight on the inside of your foot) can alter movement and distribute pressure abnormally on the forefoot, contributing to nerve inflammation.
Foot deformities like bunions or hammertoes:
These deformities change the alignment of the toe bones, which can put extra base pressure on the nerve.
Disease states like diabetes, arthritis, or obesity:
Certain medical conditions make people more prone to nerve compression and foot neuropathy/pain.
What If Morton’s Neuroma is Left Untreated?
If left untreated, Morton's neuroma will typically worsen over time and may significantly impact your day-to-day functioning and quality of life. The nerve tissue will become progressively inflamed and thickened, causing the pain to increase and spread. What starts as tingling, burning, or shooting pains only occasionally during activity can progress to chronic, searing, or electric pains that radiate from the ball of the foot out to the smaller toes.
With time, the nerve enlarges, and sensitivity worsens so that normal walking becomes unbearable. Severe debilitating sensations may also occur at rest, and even light bed sheets can be agonizing on the hypersensitive area of the foot. If left untreated for extended periods of time, often 3-5 years, the inflammation and fibrosis worsen until conservative treatments fail to provide relief. At this stage, surgery is often required to remove the enlarged and inflamed nerve tissue, repair adjacent soft tissues, and restore more normal foot innervation, mechanics, and function. Early diagnosis and conservative treatment are crucial for preserving foot health and gait.
Treatment Options for Morton’s Neuromas
The least invasive treatment options for Morton’s Neuroma are typically tried first. Surgery is considered if conservative treatments fail to provide lasting relief after 6-12 months. The specific approach depends on the severity and each patient's unique case.
Common non-surgical treatment options include:
Padding and orthotic devices:
Using pads around the ball of the foot or custom orthotics helps reduce pressure on the affected nerve. This alleviates irritation when walking.
Steroid injections:
Cortisone is injected directly into the inflamed nerve area to reduce inflammation and scar tissue formation. This can provide temporary pain relief.
Alcohol injections:
Alcohol is injected around the nerve to intentionally damage nerve fibers and prevent transmission of pain signals to the brain. Effects can last over 6 months.
Stretching, massage, ultrasound therapy, and balancing exercises can provide pain relief and help restore normal foot biomechanics.
Morton Neuroma Surgery
- Neuroma removal surgery: The enlarged/scarred nerve is surgically removed to eliminate compression and irritation. 90% of patients experience relief with this approach.
- Cryoablation surgery: The nerve area is frozen to deaden nerve fibers transmitting pain signals to the brain. This has a lower success rate than removal surgery.
- Radiofrequency ablation: Heat generated from radio wave exposure is used to target and destroy portions of the affected nerve. This can provide lasting pain relief.
Relief Awaits:
Discover Effective Morton's Neuroma Treatment in Michigan
If you are seeking treatment for Morton’s neuroma, our orthopedic services in Troy, powered by Synergy Health Partners, is the premier destination for compassionate, advanced podiatric care. Our mission is to educate patients on their conditions and provide expert recommendations for getting them back to pain-free mobility. Our Oakland County podiatrists, Jeffrey B. Klein, DPM, and Deepali Darji, DPM, are skilled specialists dedicated to addressing the root causes of your pain and restoring comfort and function. If you’re suffering from debilitating foot pain, trust Mendelson Kornblum to provide the compassionate, progressive treatment you deserve. Let our team get you back to comfortable, active living.