Morton's Neuroma

What Is Morton's Neuroma?

Morton's neuroma is a painful condition affecting the ball of the foot, typically between the third and fourth toes. It involves thickening of tissue around one of the nerves leading to the toes. It can feel like standing on a pebble or having a fold in your sock.¹

Causes and Risk Factors²

High heels (compress forefoot)
Tight, narrow shoes
High-impact activities
Foot deformities (bunions, flat feet)
Repetitive stress
More common in women

Symptoms

Sharp, burning pain in ball of foot
Feels like standing on a pebble
Numbness or tingling in toes
Pain worse with walking, especially in shoes
Relief when removing shoes
No visible lump

Diagnosis³

Physical examination
Mulder's click (clicking sensation)
Ultrasound often diagnostic
MRI in some cases
X-rays to rule out other conditions

Treatment

Self-Care

Wider shoes with low heels
Metatarsal pads
Rest from aggravating activities
Ice for pain

Medical Treatment

Custom orthotics
Anti-inflammatory medications
Corticosteroid injections
Alcohol sclerosing injections
Physical therapy

Surgical

Neurectomy (nerve removal)
Decompression surgery
When conservative treatment fails
May cause permanent numbness

Prevention

Wear shoes with wide toe box
Avoid high heels
Use padding when needed
Maintain healthy weight
Address foot mechanics issues

Prognosis

Many improve with conservative care
Surgery usually effective
May recur if footwear issues not addressed
Early treatment typically better outcomes

References

Di Caprio F, Meringolo R, Shehab Eddine M, Ponziani L. Morton's interdigital neuroma of the foot: a literature review. Foot Ankle Surg. 2018;24(4):271-277.
Jain S, Mannan K. The diagnosis and management of Morton's neuroma: a literature review. Foot Ankle Spec. 2013;6(4):307-317.
Bhatia M, Thomson L. Morton's neuroma - current concepts review. J Clin Orthop Trauma. 2020;11(3):406-409.