Morton’s neuroma is a benign, painful thickening of the tissue that surrounds one of the nerves leading to the toes, most commonly occurring between the third and fourth toes. Despite being a relatively common condition, it often goes undiagnosed or misdiagnosed because its symptoms can mimic other forefoot problems, rendering it a “hidden” cause of forefoot pain as a osteoarthritis foot doctor knows all too well. Understanding this condition is crucial for effective treatment and relief.
What Is Morton’s Neuroma?
The nerve affected in Morton’s neuroma is a small, digital nerve that supplies sensation to the toes. It becomes irritated or compressed, typically at the point where it passes between the metatarsal heads — the bones of the ball of the foot. The thickening of nerve tissue results from nerve entrapment or chronic pressure, leading to inflammation, swelling, and nerve damage over time.
Several factors predispose individuals to develop Morton’s neuroma. Repeated trauma, overuse, or excessive pressure on the forefoot can irritate the nerve. Wearing tight or narrow shoes, especially those with high heels or pointed toes, increases pressure on the front of the foot, exacerbating nerve compression. Certain foot deformities such as Morton’s foot (where the second toe is longer than the first), flat feet, or high arches alter foot biomechanics and may contribute to nerve irritation. Athletes engaging in activities involving repetitive impact on the forefoot, such as running or ballet, are also at higher risk.
The hallmark symptom of Morton’s neuroma is a sharp, burning pain in the ball of the foot, which may radiate to the toes. Patients often describe feeling like they are stepping on a pebble or having a sock bunched up in their shoe. The pain may worsen with activity and improve with rest. Many also experience numbness, tingling, or a sensation of numbness in the affected toes. Symptoms are frequently aggravated by wearing tight shoes or high heels, which compress the forefoot further.
Diagnosis
Diagnosing Morton’s neuroma involves a thorough clinical examination and history as our friends at Dynamic Foot and Ankle Center can explain. The examiner may perform a Mulder’s click test, where applying pressure to the forefoot and squeezing the metatarsal heads produces a palpable click or reproduction of symptoms. Ultrasound imaging and MRI are valuable tools that can visualize the thickened nerve and confirm the diagnosis, especially in atypical cases or when other conditions need to be ruled out.
Treatment options vary depending on the severity of symptoms. Conservative management is the first line, including wearing properly fitting shoes with a wide toe box, using metatarsal pads to offload pressure, and avoiding activities that aggravate symptoms. Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce inflammation and pain. Corticosteroid injections into the affected area may provide temporary relief by reducing swelling. Physical therapy and orthotic devices aim to correct biomechanical issues and alleviate nerve compression.
When conservative measures fail to provide relief, surgical intervention may be considered. The most common procedure involves removing the neuroma (neurectomy), which typically results in pain resolution. Postoperative recovery includes rest and gradual return to normal activities. Morton’s neuroma is a significant but often underrecognized cause of forefoot pain. Awareness of its symptoms and risk factors facilitates early diagnosis and effective management, helping patients regain comfort and mobility. Recognizing this hidden cause and the importance of a thorough evaluation in persistent forefoot pain cases. If you are experiencing pain, contact a doctor near you for help.