Morton's neuroma is a painful thickening of tissue around a nerve in the ball of the foot, usually between the third and fourth toes. It can feel like burning, tingling or standing on a pebble. Most people get relief without surgery, and our podiatrists offer treatment from orthotics and injections to surgery.
Morton's neuroma, also called an interdigital neuroma, is a thickening of the tissue around one of the nerves that run to the toes. It usually forms between the third and fourth toes, and sometimes between the second and third.
The nerve passes under a ligament that connects the toe bones (metatarsals). There, it gets squeezed between the ligament and the ground with every step. Despite its name, a Morton's neuroma isn't a true tumor, and it isn't cancer.
Morton's neuroma develops from repeated pressure on the nerve. High heels are a common cause, especially pointed ones, because they shift your body weight onto the ball of the foot. It's about eight times more common in women than in men.
Activities that put a lot of pressure on the ball of the foot can also lead to it. That includes jobs that involve crouching on your toes, like carpentry and construction work, and sports like basketball and tennis.
Morton's neuroma usually causes pain in the ball of the foot. Because it's a nerve problem, it can be hard to pinpoint exactly where it hurts. Common signs include:
If these symptoms keep coming back, have your foot examined before the nerve becomes more irritated.
A podiatrist can usually diagnose Morton's neuroma during an exam. A telltale sign is pain during the lateral squeeze test: your podiatrist presses the space between the affected toes with a thumb and finger while gently squeezing the sides of the forefoot together. Some patients also feel a click, called Mulder's sign, as the thickened tissue slips past the ligament.
A Morton's neuroma doesn't show up on an X-ray. X-rays help rule out other causes of ball-of-foot pain, such as stress fractures or arthritis. An X-ray can also show Sullivan's sign, where the toes on either side of the neuroma spread apart. If the diagnosis is unclear, an ultrasound can show the thickened tissue.
The most helpful thing you can do at home is take pressure off the ball of the foot. Wear shoes with a wide toe box and a thick, cushioned sole, and avoid high heels.
An arch support moves weight away from the ball of the foot. A metatarsal pad, placed just behind the painful area, can help too. You can stick pads directly to your foot or add them to an insert; both are sold at drugstores.
If home care doesn't help after a few weeks, it's time to see a podiatrist. Most people improve without surgery.
Treatment may include custom orthotics designed to take pressure off the nerve, anti-inflammatory medication, and cortisone injections. Injections relieve symptoms for about half of patients, and your podiatrist will talk with you about how many are safe.
If symptoms don't improve, or come back after other treatment, your podiatrist may recommend surgery. It's considered the most reliable treatment, with studies showing an 80 to 95% success rate.
Surgery either removes the thickened part of the nerve or releases the tissue pressing on it. As part of our foot and ankle surgery, removal is done through a 1½ to 2 inch incision on the top of the foot. Because it's a sensory nerve, some numbness between the toes is expected afterward. The removed tissue is sent to a lab to confirm the diagnosis.
After surgery, you can usually put weight on your foot in a post-op shoe or boot, but keep walking to a minimum for the first several days. Stitches come out at about two weeks, and most patients are back in regular shoes at around two to three weeks.
Complications are uncommon. Along with general surgical risks like infection or bleeding under the skin, there's a small chance of a stump neuroma, where the cut end of the nerve forms a painful bulb as it tries to regrow. If it's caught early, it's treated like the original neuroma, with anti-inflammatories and injections. If that doesn't work, it can be removed.
A Morton's neuroma can also come back, even after successful surgery.
Looking for a Morton's neuroma specialist? Our podiatrists diagnose and treat it at our offices in Metairie, Covington and Prairieville, from shoe changes and orthotics to surgery.
Pain in the ball of the foot can have other causes, too. Our Foot & Heel Pain page covers them.
It usually doesn't go away completely on its own. Symptoms often ease, though, when you take pressure off the nerve with better shoes, pads or orthotics. The earlier you make those changes, the better your chance of avoiding surgery.
Both cause pain in the ball of the foot. Metatarsalgia is pain and inflammation around the joints at the base of the toes, usually felt as an ache. Morton's neuroma is a nerve problem, so it more often causes burning, tingling or numbness between two toes.
From the outside, usually nothing. You won't normally see a lump or swelling, because the thickened tissue sits deep between the toe bones. Sometimes the toes on either side spread apart.
