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

Morton’s Neuroma is a painful condition that affects the ball of the foot, most commonly between the third and fourth toes. It occurs when the tissue around one of the nerves leading to the toes thickens, causing sharp pain, burning sensations or numbness in the affected area. This article explores the causes, symptoms and treatment options for Morton’s Neuroma, drawing on respected podiatry and orthopaedic sources.

What Is Morton’s Neuroma?

Also known as intermetatarsal neuroma, Morton’s Neuroma is a benign thickening of nerve tissue often linked with numbness, tingling, or pain in the forefoot. It most often occurs between the third and fourth toes but can develop elsewhere. According to the American Academy of Orthopaedic Surgeons (AAOS), it is most common in middle-aged women, especially those who wear tight or high-heeled shoes that compress the forefoot.

Causes of Morton’s Neuroma

The exact cause of Morton’s Neuroma is not fully understood, but several contributing factors have been identified:

• Foot Structure: People with flat feet, high arches, bunions, or hammertoes are more susceptible. These conditions can cause instability in the metatarsal region, leading to increased pressure on the nerve.
• Footwear with Poor Insoles: Shoes with narrow toe boxes or high heels can squeeze the toes and irritate the nerves, eventually causing inflammation and thickening of the nerve tissue.
• Repetitive Stress: High-impact activities such as running, dancing, or certain sports can place repetitive stress on the forefoot, increasing the risk of developing a neuroma.
• Injury: Previous foot injuries can damage nerves or surrounding tissues, predisposing the area to neuroma formation.

Symptoms of Morton’s Neuroma

Symptoms often develop gradually and can vary in severity. Common signs include:

• Sharp, Burning Pain: Typically felt in the ball of the foot and radiating into the toes. The pain may worsen with tight shoes or activity and ease when the shoes are removed.
• Numbness or Tingling: A “pins and needles” sensation, especially between the third and fourth toes.
• Feeling of a Lump or Pebble: Many patients describe the sensation of standing on a pebble, even though no visible lump exists.
• Pain When Walking: Pain may intensify with walking or weight-bearing, leading some individuals to alter their gait to relieve pressure.

Diagnosis of Morton’s Neuroma

A diagnosis typically begins with a physical examination, during which a healthcare professional will press on the forefoot to identify tenderness or pain. According to the Mayo Clinic, imaging tests such as X-rays, ultrasound, or MRI scans may be used to confirm the diagnosis and rule out other conditions like fractures or arthritis.

Treatment Options for Morton’s Neuroma

Treatment aims to relieve pain, reduce pressure, and prevent further irritation of the affected nerve. Options include both conservative and surgical approaches, depending on symptom severity.

1. Footwear Modifications

Wearing shoes with a wide toe box, low heels, and good arch support can alleviate nerve compression. Avoid shoes that squeeze the toes or force weight onto the front of the foot.

2. Orthotic Insoles

Orthotic insoles - either prefabricated or custom-made—help support the arch and cushion the forefoot. They relieve pressure on the neuroma and improve overall foot alignment. Soft, shock-absorbing materials such as Poron, Plastazote, or low-density EVA foam are ideal choices for added comfort.

3. Padding and Taping

Metatarsal pads and taping techniques can redistribute pressure across the forefoot and reduce strain on the affected nerve. This conservative method works well when combined with appropriate footwear.

4. Activity Modification

Reducing or avoiding activities that aggravate symptoms—such as running or prolonged standing—can help manage pain. Consider switching to low-impact exercises like swimming or cycling to stay active without stressing the foot.

5. Medications

Over-the-counter pain relievers such as ibuprofen or naproxen can reduce inflammation. In more severe cases, a podiatrist may recommend corticosteroid injections to provide longer-lasting relief from nerve irritation.

6. Physical Therapy

Physical therapy strengthens and stretches the muscles of the foot and calf, helping to improve flexibility and decrease pressure on the nerve. Exercises focusing on toe spreading, arch strengthening, and calf stretching can be particularly beneficial.

7. Surgery

If conservative treatments fail, surgery may be considered. Common procedures include neurectomy (removal of the neuroma) or decompression surgery (cutting nearby ligaments to relieve nerve pressure). According to the Cleveland Clinic, surgical treatment has a high success rate, though risks such as numbness or persistent pain should be discussed beforehand.

Prevention of Morton’s Neuroma

Preventing Morton’s Neuroma primarily involves avoiding excessive forefoot pressure and maintaining proper foot alignment. To reduce your risk:

• Wear Proper Footwear: Choose shoes with adequate width, cushioning, and support. Avoid high heels and narrow styles that compress the toes.
• Use Orthotic Insoles: If you have a predisposition to forefoot issues, insoles designed for Morton’s Neuroma can reduce nerve irritation.
• Take Breaks During Activity: Avoid prolonged high-impact exercise without rest. Ensure shoes provide proper support during sports.
• Maintain a Healthy Weight: Reducing body weight lessens overall pressure on the feet, decreasing neuroma risk.

Consult a Podiatrist

Morton’s Neuroma can significantly affect mobility and quality of life if left untreated. By recognising the symptoms early and taking steps to address the underlying causes - such as changing footwear or using orthotic insoles - you can manage discomfort and prevent further progression. If pain persists, consult a podiatrist or orthopaedic specialist for diagnosis and tailored treatment. With the right care, most individuals can achieve lasting relief and return to pain-free activity.

References

• "Morton’s Neuroma: Symptoms, Causes, and Treatment." American Academy of Orthopaedic Surgeons (AAOS).
• "Footwear and Morton’s Neuroma." American Podiatric Medical Association.
• "Diagnosis and Imaging of Morton’s Neuroma." Mayo Clinic.
• "Conservative Treatments for Morton’s Neuroma." Cleveland Clinic.
• "Surgical Outcomes for Morton’s Neuroma." Journal of Foot and Ankle Surgery.
• "Role of Orthotics in Morton’s Neuroma." National Institute for Health and Care Excellence (NICE).
• "Physical Therapy for Morton’s Neuroma." Journal of Podiatric Medicine.
• "Foot Structure and Morton’s Neuroma Risk." British Journal of Sports Medicine.
• "Impact of High Heels on Foot Health." American Orthopaedic Foot & Ankle Society.
• "Preventing Morton’s Neuroma." American Academy of Podiatric Sports Medicine.