Morton's neuroma

Morton's neuroma is a condition that affects one of the nerves between the toes.

Introduction

Morton's neuroma is a condition that affects one of the nerves between the toes. The nerve becomes irritated and compressed, which results in severe pain on the ball of the foot and at the base of the toes.

Morton's neuroma usually affects the nerve between the third and fourth toes. It is rare for more than one nerve or foot to be affected.

You may initially experience a tingling sensation in the space between your third and fourth toes, which gets worse over time. This leads to cramp in your toes and a sharp shooting or burning pain on the ball of your foot or at the base of your toes.

The pain is often worse when you wear shoes that press on the affected area and when you are walking.

Read more about the symptoms of Morton's neuroma.

What causes Morton's neuroma?

The pain of Morton's neuroma occurs when the nerve that connects the toe bones (metatarsal bones) becomes irritated or compressed.

The exact cause of the irritation is unknown, but it may be due to the metatarsal bones pressing against the nerve when the gap between the bones is narrow. This causes the nerve and surrounding tissue to thicken.

Some experts believe that a number of other foot problems, including flat feet, high foot arches, bunions and hammer toes, may also play a role in Morton's neuroma.

Read more about the causes of Morton's neuroma.

When to see your doctor

If you have continual tingling or persistent pain in your foot, you should make an appointment to see a podiatrist (a specialist in foot problems). Alternatively, you could visit your doctor, who may refer you to a podiatrist.

Your doctor or podiatrist may examine your foot and ask you some questions to find out:

  • how much pain you are in and what it feels like
  • when your symptoms started
  • what type of shoes you usually wear
  • about your work, lifestyle and sporting activities

Your doctor or podiatrist may also refer you for a scan, such as an X-ray, ultrasound scan or magnetic resonance imaging (MRI) scan, to get a detailed image of the inside of your foot.

Who is affected by Morton's neuroma?

Anyone can get Morton's neuroma, but women are most commonly affected. In particular, the condition tends to occur in:

  • women who wear high-heeled shoes
  • people who do regular exercise, especially running
  • people with a particular foot shape, such as a high arch

Treating Morton's neuroma

You will probably be advised to wear shoes with a wider toe area and take painkillers to ease the pain. Steroid injections may also be given to treat the affected nerve.

If this doesn't work, surgery may be needed. Surgery involves removing the thickened tissue around the nerve (and sometimes the nerve itself) to release the pressure.

Read more about how Morton’s neuroma is treated.

Symptoms

If you have Morton's neuroma, you may initially feel a tingling sensation in the space between your third and fourth toes.

This is caused by irritation of the nerve between your third and fourth toe bones (metatarsal bones).

The tingling will eventually lead to pain, which can get progressively worse over time. You may also experience cramping of your toes.

The pain is usually felt as a sharp shooting or burning pain on the ball of the foot or at the base of the toes, which is often made worse when you are walking.

Some people with Morton's neuroma feel anxious about walking or even placing their foot on the ground.

The pain is likely to be more intense if you wear tight shoes, so wearing shoes that have more room in the toe area can help. Rubbing your foot may also lessen the pain.

Read more about treating Morton's neuroma.

Causes

Exactly what causes Morton's neuroma is not always known, but there are several things that seem to aggravate it. These include other foot-related problems and wearing restrictive footwear.

It is thought that Morton's neuroma may be caused by the toe bones (metatarsal bones) pressing against the nerve when the gap between the bones is narrow. This causes the nerve and surrounding tissue to thicken.

Footwear

Wearing shoes that are too tight can make the pain of Morton's neuroma worse. This is because the toe bones are more likely to press on the affected nerve if your shoes are too tight.

High-heeled shoes, particularly those over 5cm (2 inches) or those that have a pointed or tight toe area, can also compress the toes and make the pain worse. This is why women tend to be affected by the condition more than men.

Foot conditions

Some experts also believe that other foot conditions may be associated with Morton's neuroma. This is because other conditions may cause the metatarsal bones to rub against the nerve in your foot.

Foot problems that may increase your risk of developing the condition include:

  • abnormally positioned toes
  • high arches – where the arch or instep of your foot is raised more than normal
  • flat feet – low arches or no arches at all
  • bunion – a bony swelling at the base of the toe
  • hammer toe – where the toe is bent at the middle joint

Sporting activities

Being active and playing sport can make the painful symptoms of Morton's neuroma worse.

In particular, running or sports that involve running (such as racquet sports) can place extra pressure on the nerve in your foot, which can aggravate the problem.

Treatment

Treatment for Morton’s neuroma will depend on how long you have had the condition and how severe it is. For some people, simple non-surgical treatments are effective, but others may need to have surgery.

Non-surgical treatments

If Morton's neuroma is diagnosed at an early stage, treatment will aim to reduce the pressure on the affected nerve, which is usually the nerve between the third and fourth toe bones (metatarsals).

For example, your doctor or podiatrist (foot specialist) may recommend:

  • changing the type of shoes that you usually wear – shoes with a wider toe area may help to ease the pressure on the nerve in your foot
  • using orthotic devices – such as a support for the arch of your foot to help relieve the pressure on the nerve
  • painkilling medication – anti-inflammatory painkillers or a course of steroid injections into the affected area of the foot may help ease the pain and inflammation
  • numbing injections – alcohol and local anaesthetic is injected into the affected area of the foot using ultrasound for guidance (studies have shown that this type of treatment is effective)

Resting your foot and massaging your toes may also help to relieve the pain. You can make an ice pack by freezing a small bottle of water and rolling it over the affected area.

Surgery

Surgery may be needed if non-surgical treatments haven't worked or the pain in your foot is severe.

Surgery is usually carried out under local anaesthetic and is usually performed on an outpatient basis, which means you will not have to stay in hospital overnight. The operation can take up to 30 minutes.

The surgeon will make a small incision, either on the top of your foot or on the sole. They may try to increase the space around the nerve (nerve decompression) by removing some of the surrounding tissue, or they may remove the nerve completely (nerve resection). If the nerve is removed, the area between your toes may be permanently numb.

After the procedure you will need to wear a special protective shoe until the affected area has healed sufficiently for you to wear normal footwear. It can take up to four weeks to make a full recovery.

Most people (about 75%) who have surgery to treat Morton's neuroma have positive results and their painful symptoms are relieved.

Complications

As with all surgery, complications can occur and you should discuss these with your surgeon before you have the procedure.

Two possible complications that can occur following surgery for Morton's neuroma include:

  • infection around the toes
  • thickening of the skin on the sole of the foot (plantar keratosis), which may require further treatment
Content supplied by NHS Choices