Introduction

Morton's neuroma
Morton's neuroma

Morton's neuroma is a painful foot condition that affects one of the nerves between the toes.

It's also known as Morton's metatarsalgia or interdigital neuroma.

In Morton's neuroma, a nerve in the foot becomes irritated and thickened, which can cause severe pain.

The condition can occur in one foot or both feet. It usually affects the nerve between the third and fourth toes, but sometimes the second and third toes are affected.

Morton's neuroma can occur at any age, but most often affects middle-aged women. This may be because women tend to wear tight or high-heeled shoes that can put pressure on the feet.

It's also increasingly seen in runners, possibly because of the increased pressure on the toes that occurs when running.

Symptoms of Morton's neuroma

You may initially experience a tingling sensation in the space between your toes, which gets worse over time. This eventually develops into a sharp shooting or burning pain in the ball of your foot or at the base of your toes. There may also be some numbness in your toes.

The pain is often worse when walking or wearing shoes that squash the feet. Some people describe walking with Morton's neuroma as feeling like there's a small stone stuck under your foot. Removing your shoes and rubbing your foot may reduce the pain.

When to seek medical advice

It's a good idea to make an appointment to see a podiatrist (specialist in foot problems) if you have persistent symptoms of Morton's neuroma, as the condition is unlikely to improve on its own. You could also visit your GP, who may refer you to a podiatrist.

Your GP or podiatrist may examine your foot and ask you some questions to find out:

  • about the pain and what it feels like
  • when your symptoms started
  • what type of shoes you usually wear
  • about your work, lifestyle and sporting activities

They can also suggest simple measures you can try at home to reduce your symptoms, or recommend other treatments.

What causes Morton's neuroma?

Morton's neuroma occurs when one of the nerves between the toe bones becomes irritated, which causes it to become thicker. The exact cause of the irritation is unknown, but it may be caused by the nerve being squashed (compressed), stretched or damaged.

The condition has been linked to:

  • wearing tight, pointy or high-heeled shoes
  • being active and playing sport – particularly running or sports that involve running and placing pressure on the feet, such as racquet sports
  • other foot problems, such as flat feet, high arches, bunions and hammer toes

It's not clear if these directly cause the condition or just make the symptoms worse.

Treating Morton's neuroma

Treatment for Morton's neuroma will depend on how long you've had the condition and its severity. Simple non-surgical treatments are effective for some people. Others may need surgery.

Non-surgical treatments

At first, your podiatrist or GP may recommend:

  • changing your footwear – shoes with a wider toe area may help ease the pressure on the nerve in your foot
  • orthotic devices – a soft pad for the ball of your foot may help relieve the pressure on the nerve
  • painkillers – taking over-the-counter anti-inflammatory painkillers, such as ibuprofen, may help ease the pain and inflammation
  • losing weight – if you're overweight, losing weight may reduce the strain on your feet
  • injections – injections of a steroid medication or alcohol solution alongside a local anaesthetic may offer some pain relief

Resting your foot and massaging your toes may also help relieve the pain. Some people also find it useful to hold an ice pack against their foot.

A relatively new procedure called cryosurgery (or cryotherapy), where a small probe is inserted into the foot and used to destroy the thickened nerve tissue by freezing it, is also sometimes used to treat Morton's neuroma. However, this is still fairly experimental and isn't widely available in the UK. You'll usually have to pay for it privately.

Surgery

Surgery for Morton's neuroma is usually only recommended if you have very severe pain or if the treatments above haven't worked. In this case, your GP can refer you to a podiatric or orthopaedic surgeon to discuss whether surgery is suitable for you.

During the operation, a small incision is made on the top or bottom of your foot so the surgeon can access the affected nerve. They will then either:

  • increase the space around the nerve by removing some of the surrounding tissue, or
  • remove part of the nerve – if this is done, the area between your toes will be permanently numb

The procedure is usually carried out using a general anaesthetic or local anaesthetic. You normally won't need to stay in hospital overnight.

After the procedure, you'll need to wear a special protective shoe until the affected area has healed enough to wear normal footwear. You can usually walk soon after the operation, although it will take weeks or months to make a full recovery.

Most people who have surgery to treat Morton's neuroma have positive results and their pain is relieved afterwards.

As with all types of surgery, however, complications can occur, such as swelling, infection and pain. You should discuss the risks with your surgeon before having the procedure.

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Symptoms

If you have Morton's neuroma, you may initially feel a tingling sensation in the space between your third and fourth toes or second and third toes.

This is caused by irritation of the nerve between your third and fourth toe bones (metatarsal bones).

The tingling will eventually lead to pain, which can progressively get worse over time. You may also experience cramping of your toes.

The pain is usually felt as a sharp shooting or burning pain on the ball of the foot or at the base of the toes, which is often made worse when you are walking.  

Some people with Morton's neuroma feel anxious about walking or even placing their foot on the ground.

The pain is likely to be more intense if you wear tight shoes, so wearing shoes that have more room in the toe area can help. Rubbing your foot may also lessen the pain.

Read more about treating Morton's neuroma.

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Causes

Exactly what causes Morton's neuroma is not always known, but there are a number of things that seem to aggravate it. These include other foot-related problems and wearing restrictive footwear.

It is thought that Morton's neuroma may be caused by the toe bones (metatarsal bones) pressing against the nerve when the gap between the bones is narrow. This causes the nerve and surrounding tissue to thicken.

Footwear

Wearing shoes that are too tight can make the pain of Morton's neuroma worse.  This is because the toe bones are more likely to press on the affected nerve if your shoes are too tight.

High-heeled shoes, particularly those over 5cm (2 inches) or those that have a pointed or tight toe area, can also compress the toes and make the pain worse. This is why women tend to be affected by the condition more than men.

Foot conditions

Some experts also believe that other foot conditions may be associated with Morton's neuroma because they may cause the metatarsal bones to rub against the nerve in your foot.

Foot problems that may increase your risk of developing the condition include:

  • abnormally positioned toes
  • high arches - where the arch or instep of your foot is raised more than normal
  • flat feet - low arches or no arches at all
  • bunion - a bony swelling at the base of the toe
  • hammer toe - where the toe is bent at the middle joint 

Sporting activities

Being active and playing sport can make the painful symptoms of Morton's neuroma worse.

In particular, running or sports that involve running (such as racquet sports) can place extra pressure on the nerve in your foot, which can aggravate the problem.

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Diagnosis

Your GP or podiatrist will probably ask you:

  • how much pain you are in and what it feels like
  • when your symptoms started
  • your work, lifestyle and hobbies
  • the type of shoes you normally wear

Your GP may refer you to a podiatrist, who will normally examine your foot and feel the toes to try to locate the irritated nerve.

Your GP or podiatrist may refer you for an X-ray, an ultrasound scan or a magnetic resonance imaging (MRI) scan, to get a detailed image of the inside of your foot. An ultrasound uses high-frequency sound waves to build up a picture, while an MRI scan uses strong magnetic fields.

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Treatment

Treatment for Morton’s neuroma will depend on how long you have had the condition and how severe it is. For some people, simple non-surgical treatments are effective, but others may need to have surgery. 

Non-surgical treatments

If Morton's neuroma is diagnosed at an early stage, treatment will aim to reduce the pressure on the affected nerve, which is usually the nerve between the third and fourth toe bones (metartarsals).

For example, your GP or podiatrist (foot specialist) may recommend:

  • changing the type of shoes that you usually wear - shoes with a wider toe area may help to ease the pressure on the nerve in your foot
  • using orthotic devices - such as a support for the arch of you foot to help relieve the pressure on the nerve 
  • painkilling medication - anti-inflammatory painkillers or a course of steroid injections into the affected area of the foot may help ease the pain and inflammation
  • numbing injections - alcohol and local anaesthetic is injected into the affected area of the foot under ultrasound guidance; studies have shown that this type of treatment is effective

Resting your foot and massaging your toes may also help to relieve the pain. You can make an ice pack by freezing a small bottle of water and rolling it over the affected area.

Cryotherapy is a new non-surgical treatment that can be used to treat Morton's neuroma. It involves using very cold temperatures to destroy the affected nerve tissue and disrupt its blood supply.

However, there’s no evidence to prove that cryotherapy works and it’s not recommended by the National Institute for Health and Care Excellence (NICE). It is also only available privately

Surgery

Surgery may be needed if non-surgical treatments haven't worked or the pain in your foot is severe.

Surgery is usually carried out under local anaesthetic and is usually performed on an outpatient basis, which means you will not have to stay in hospital overnight. The operation can take up to 30 minutes.

The surgeon will make a small incision, either on the top of your foot or on the sole. They may try to increase the space around the nerve (nerve decompression) by removing some of the surrounding tissue, or they may remove the nerve completely (nerve resection). If the nerve is removed, the area between your toes may be permanently numb.

After the procedure you will need to wear a special protective shoe until the affected area has healed sufficiently for you to wear normal footwear. It can take up to four weeks to make a full recovery.

Most people (about 75%) who have surgery to treat Morton's neuroma have positive results and their painful symptoms are relieved.

Complications

As with all surgery, complications can occur and you should discuss these with your surgeon before you have the procedure.

Two possible complications that can occur following surgery for Morton's neuroma include:

  • infection around the toes
  • thickening of the skin on the sole of the foot (plantar keratosis), which may require further treatment

Can Morton's neuroma be prevented?

Wearing shoes that fit properly and that have plenty of room in the toe area may help prevent Morton's neuroma.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 26/10/2015 09:41:42