Morton's neuroma

Morton’s neuroma is a benign thickening of nerve tissue between the toes. It usually presents on the nerve attached between the third and fourth toes.

Causes, incidence, and risk factors

This condition has a higher incidence in women than men. While the exact cause is unknown some experts speculate that the following contribute to incidences of this condition:

• Abnormal positioning of toes
• Flat feet, high foot arches and forefoot problems
• Tight, narrow shoes and high heels Symptoms

• Tingling in the affected nerve
• Cramping of toes near the affected nerve
• Burning pain radiating into the ball of your foot into the toes
• Wearing shoes or pressing on the area causes pain
• Increasing pain over time
• Numbness in the toes may also occur

In rare cases, nerve pain occurs in the space between the second and third toes. This is not a common form of Morton's neuroma, but treatment is similar.

Diagnosis

Your orthopaedic surgeon will:

• Take a complete medical history
• Perform a physical exam to determine the area of pain , identify any tenderness in the affected areas and determine any range of motion (ROM) deficiencies
• Request x-rays, high resolution ultrasound and Magnetic Resonance Imaging (MRI) to confirm diagnosis and to rule out arthritis or stress fractures in the bone
• Order routinely performed blood tests to check for infection and types of arthritis

Treatment

Nonsurgical treatment is tried first. Your doctor may recommend any of the following:

• Orthotics – custom inserts and pads to reduce pressure on the nerve
• Changes to footwear – avoid high heels and tight shoes, wear wider, soft soled shoes
• Use of oral anti-inflammatory medicine (though not recommended for long-term treatment)
• Nerve blocking medicines injected into the toe area
• Other painkillers
• Physical therapy

Your orthopaedic surgeon may recommend surgery if conservative treatments fail to provide relief of your symptoms. It involves removing the thickened tissue or a small portion of the nerve. This may help to relieve pain and improve foot function. Any numbness experienced after surgery would be permanent, but not painful.