Montana Foot & Ankle

Understanding Morton’s Neuroma: Causes, Symptoms, and Treatment Options

As a podiatrist, one of the more common conditions I encounter in my practice is Morton’s neuroma, a painful foot condition that often affects individuals who spend significant time on their feet. Whether you are an athlete, a lover of the outdoors, or someone who simply enjoys regular walks, understanding the nature of Morton’s neuroma can help you prevent or manage this condition. Let’s dive into the causes, symptoms, and treatment options available for this foot ailment.

What is Morton’s Neuroma?

Morton’s neuroma is a thickening of the tissue surrounding one of the nerves leading to your toes. It usually occurs between the third and fourth toes and causes sharp, burning pain in the ball of the foot. This pain can spread to the toes and may feel like you are standing on a small pebble or a fold in your sock.

The condition is not a true neuroma (a tumor of the nerve), but rather a thickening of the tissue around the nerve due to irritation or compression. When the nerve becomes compressed, it becomes inflamed, leading to the symptoms we associate with Morton’s neuroma.

Causes and Risk Factors

The exact cause of Morton’s neuroma is not entirely understood, but there are several contributing factors that increase the risk of developing it:

  • Footwear: Wearing shoes that are too tight, have a narrow toe box, or high heels can put extra pressure on the toes and the balls of your feet, which can contribute to the development of Morton’s neuroma. High heels, in particular, shift body weight to the front of the foot, increasing pressure and stress on the nerves.
  • Foot Structure: People with foot deformities, such as flat feet, high arches, or bunions, are more prone to Morton’s neuroma. Abnormal foot mechanics can place extra stress on the ball of the foot, which can lead to nerve irritation.
  • Repetitive Activities: Activities that involve high impact on the feet, such as running, jumping, or even prolonged standing, can increase the likelihood of developing this condition. Athletes, especially runners, are at higher risk due to the repetitive stress on their feet.
  • Trauma: Any injury to the foot, particularly in the area of the forefoot, can lead to the development of Morton’s neuroma. A past injury may cause scar tissue formation, which can compress or irritate the nerve over time.

Symptoms of Morton’s Neuroma

The hallmark symptom of Morton’s neuroma is pain in the ball of the foot, particularly between the third and fourth toes. Other common symptoms include:

  • Sharp or burning pain: This is typically felt between the toes and may radiate down into the toes themselves.
  • Numbness or tingling: Some patients describe a feeling of numbness or pins and needles in their toes.
  • A sensation of walking on a pebble: Patients often feel like there’s something bunched up in their shoe, like a small stone or a fold in their sock.
  • Pain during specific activities: Walking, running, or wearing shoes that put pressure on the forefoot often aggravates the symptoms.

The pain may come and go, but as the condition progresses, it tends to become more persistent and severe.

Diagnosis

Diagnosing Morton’s neuroma typically involves a clinical evaluation where a podiatrist examines your foot and asks about your symptoms. A simple test involves squeezing the foot from the sides while pressing on the ball of the foot, which can reproduce the pain. This test is often accompanied by a “clicking” sensation known as Mulder’s sign. In some cases, imaging studies like an X-ray, ultrasound, or MRI may be ordered to rule out other causes of forefoot pain, such as fractures or arthritis, and to confirm the diagnosis.

Treatment Options

The good news is that Morton’s neuroma is treatable, especially when diagnosed early. Treatment options range from conservative methods to more invasive procedures, depending on the severity of the condition.

1. Conservative Treatments

  • Footwear Changes: Switching to shoes with a wider toe box and better arch support can alleviate the pressure on the nerve. Avoiding high heels and shoes that compress the toes is crucial.
  • Orthotics: Custom-made orthotics or padding can help redistribute pressure across the foot and reduce nerve irritation.
  • Activity Modification: Reducing or modifying activities that put stress on the forefoot can help. For example, switching from high-impact activities like running to low-impact exercises like swimming or cycling may relieve symptoms.
  • Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help manage pain and inflammation.
  • Corticosteroid Injections: If conservative measures don’t provide relief, corticosteroid injections into the affected area can help reduce inflammation and pain.

2. Surgical Treatment

When conservative treatments fail to relieve symptoms, surgery may be considered. The surgical procedure involves removing the thickened tissue or, in some cases, removing part of the nerve itself. While surgery has a high success rate, it may result in some permanent numbness in the affected toes.

Prevention

While it’s not always possible to prevent Morton’s neuroma, there are several steps you can take to reduce your risk:

  • Wear shoes that fit properly and provide ample room in the toe box.
  • Avoid high heels or shoes that squeeze your toes together.
  • Use custom orthotics if you have flat feet or other foot deformities.
  • Incorporate foot stretches and strengthening exercises into your routine to support healthy foot mechanics.
  • Take breaks and modify your activities to avoid excessive stress on your feet.

Morton’s neuroma is a common but painful foot condition that can significantly impact your daily life. By understanding the causes, recognizing the symptoms, and seeking prompt treatment, you can manage this condition and return to your regular activities. If you suspect you have Morton’s neuroma or experience persistent foot pain, consult with a podiatrist like Dr. Wright for an accurate diagnosis and personalized treatment plan. Taking care of your feet is essential for maintaining your overall mobility and quality of life.