Morton neuroma
Morton neuralgia; Morton toe syndrome; Morton entrapment; Metatarsal neuralgia; Plantar neuralgia; Intermetatarsal neuralgia; Interdigital neuroma; Interdigital plantar neuroma; Forefoot neuroma; Morton's neuroma
Morton neuroma is an injury to the nerve between the toes that causes thickening and pain. It commonly affects the nerve that travels between the 3rd and 4th toes.
Causes
The exact cause is unknown. Health care providers believe the following may play a role in the development of this condition:
- Wearing tight shoes and high heels
- Abnormal positioning of toes
- Flat feet
- Forefoot problems, including bunions and hammer toes
- High foot arches
Morton neuroma is more common in women than in men.
Healthy feet often travel miles each day. You use them to get up and down supermarket aisles, climb stairs, and walk on the treadmill, among other things. Any pain or discomfort in your feet can really slow you down and impact your life. Let's talk about foot pain, and what to do if you have it. A lot of different things can cause foot pain, including those stiletto heels you couldn't resist passing by the shoe store window at the mall. Wearing poorly fitting or high-heeled shoes day after day can squeeze and pinch your feet until they start to hurt. For example, shoes that are too narrow can cause bunions, swollen bumps at the base of your big toe. Wearing shoes that are too tight can curl your toes until they look like a claw. That's called a hammer toe. When your feet rub against your shoes, you can get areas of thickened skin called calluses or corns. And too much pressure from your shoes on the soles of your feet can create an opening for a viral infection called plantar warts. If your shoes aren't a problem, you may have one of several conditions that cause foot pain. Arthritis, a fractured or broken bone, gout, tendinitis, plantar fasciitis can all make your feet hurt. You're more likely to have foot problems as you get older and your joints wear down. Being overweight puts extra pressure on your feet, which can also lead to pain. So, what do you do if your feet hurt? That depends on what's causing your pain. Sometimes you can treat foot pain at home. For example, you can hold ice to your foot to bring down swelling, and take an over-the-counter pain reliever such as ibuprofen or acetaminophen. Try to keep off the painful foot as much as you can. Sit with your feet raised until they start to feel at least a bit better. Wearing foot pads and other shoe inserts may also help your feet heal and prevent future pain. Sometimes you'll need to see a doctor, especially if the pain is due to an injury, or it's severe, or it hasn't improved after a couple of weeks of treatment at home. Your podiatrist can examine your feet, diagnose the problem, and remove any growths like warts, corns, or calluses. A foot doctor can also treat a broken or fractured bone. Depending on how serious the problem is, you may even need surgery to treat it. There are ways to prevent foot pain before it can start-like being careful when you exercise. Working out is great, but you never want to run or jump hard enough to damage your feet. Losing weight can also help take some of the pressure off of your feet. Probably the kindest thing you can do for your feet is to wear comfortable shoes. Your shoes should fit properly, supporting and cushioning your feet while leaving plenty of room for your toes to wiggle around. So, when you're shoe shopping, leave the stilettos on the shelf, and reach for a comfortable, attractive option instead. Your feet will thank you by not causing you pain.
Symptoms
Symptoms may include:
- Numbness and tingling in the space between the 3rd and 4th toes
- Toe cramping
- Sharp, shooting, or burning pain in the ball of the foot and sometimes toes
- Pain that increases when wearing tight shoes, high heels, or pressing on the area
- Pain that gets worse over time
In rare cases, nerve pain occurs in the space between the 2nd and 3rd toes. This is not a common form of Morton neuroma, but symptoms and treatment are similar.
Exams and Tests
Your provider can usually diagnose this problem by examining your foot. Squeezing your forefoot or toes together bring on the symptoms.
A foot x-ray may be done to rule out bone problems. MRI or ultrasound can successfully diagnose the condition.
Nerve testing (electromyography) cannot diagnose Morton neuroma. But it may be used to check for conditions that cause similar symptoms.
Blood tests may be done to check for inflammation-related conditions, including certain forms of arthritis.
Treatment
Nonsurgical treatment is tried first. Your provider may recommend any of the following:
- Padding and taping the toe area
- Shoe inserts (orthotics)
- Changes to footwear, such as wearing shoes with wider toe boxes or flat heels
- Anti-inflammatory medicines taken by mouth or injected into the area between the toes
- Nerve blocking medicines injected into the toe area
- Other painkillers
- Physical therapy
Anti-inflammatories and painkillers are not recommended for long-term treatment.
In some cases, surgery is needed to remove the thickened tissue and inflamed nerve. This helps relieve pain and improve foot function. Numbness after surgery is permanent.
Outlook (Prognosis)
Nonsurgical treatment does not always improve symptoms. Surgery to remove the thickened tissue is successful in most cases.
Possible Complications
Complications may include:
- Difficulty walking
- Trouble with activities that put pressure on the foot, such as pressing the gas pedal while driving
- Difficulty wearing certain types of shoes, such as high-heels
When to Contact a Medical Professional
Contact your provider if you have constant pain or tingling in your foot or toe area.
Prevention
Avoid ill-fitting shoes. Wear shoes with a wide toe box or lower heels.
References
McGee DL. Podiatric procedures. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts & Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 51.
Shi GG. Morton's neuroma. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 91.
Version Info
Last reviewed on: 4/24/2023
Reviewed by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
