Morton’s Neuroma

Morton’s neuroma is a common cause of pain in the lateral forefoot. People who have Morton's neuroma complain of their pain in different ways. Some feel like they are walking on a marble or stone under the area in the ball of their foot. Some people get shooting, burning or stabbing pains in either the third or fourth toes. Some people describe the pain as if they are walking on something balled up under their foot. This can also occur in the area between the second and third toes, but is very rare in the areas between the fourth and fifth, and between the first and second toes.

How A Morton's Neuroma Develops
Morton’s neuroma is caused by irritation of a nerve that travels between the metatarsal bones just before branching to the sides of the toes. The nerve in that area passes directly under a ligament. When the nerve rubs against the undersurface of the ligament it can get irritated. That may cause it to swell, which in turn makes it easier to get irritated. An increasing cycle of swelling and pain may then develop.

Morton's neuroma may be aggravated by some activities such as repeated impact activities. It also seems to be associated with wearing tight shoes, and wearing elevated heels. Tight shoes diminish the space for the nerve to pass through. Shoes with elevated heels stretch the nerve against the undersurface of the ligament that runs between the metatarsal bones, and increase the chance of the nerve being irritated.

Diagnosis
Morton's neuromas are not seen on x-rays, and rarely can be seen with an MRI study. The diagnosis is made based on the physical examination, and your complaints. There is nothing visible to the naked eye that looks unusual when you have a Morton's neuroma. Patients with Morton's neuroma will have tenderness between the heads of the metatarsals when those areas are squeezed. It is important to differentiate tenderness coming from the area between the metatarsals, and tenderness from the bones themselves.

Treatment
As with most forefoot complaints, it is best to first try to find shoes that are comfortable. Generally a flat shoe with a wide toebox will feel best for most people. Because there is inflammation about the nerve, some people will have improvement by taking an oral anti-inflammatory medication such as ibuprofen (Advil) or naproxen (Aleve). If these measures are not satisfactory, and symptoms persist, it is appropriate to consider an injection of cortisone into the area of tenderness. For patients who do not get relief with these conservative measures, surgical treatment can be discussed.

In general, the surgical treatment involves cutting the nerve between the toes. That generally eliminates the pain, but there will be numbness along the sides of the toes in that area. The specific risk of that surgery is that there is a chance that pain may persist due to irritation of the end of the nerve that has been cut. If that should occur, we call that a "stump neuroma". That in turn may require further treatment.

For more information about Morton's Neuroma look at the AAOS Website.

Go here for information about Morton's Neuroma Surgery. here.