Morton's Neuroma

A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton’s neuroma, which occurs between the third (middle) and forth toes. It is sometimes referred to an inter-metatarsal neuroma. “Inter-metatarsal” describes its location in the ball of the foot between the metatarsal bones. Neuromas may also occur in other locations in the foot.

The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage.

What causes a Neuroma?

Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offender is wearing shoes that have tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box.

People with certain foot deformities – bunions, hammertoes, flat feet, or more flexible feet, are at higher risk for developing a neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or court sports. An injury of other type of trauma to the area may also lead to a neuroma.

To arrive at a diagnosis, to podiatrist will obtain a through history of your symptoms and examine your foot. During the physical examination, the doctor attempts to reproduce your symptoms by manipulating your foot. Other tests or imaging studies such as x-ray or ultrasound may be performed. The best time to see your podiatrist is early in the development of symptoms. Early diagnosis or a Morton’s neuroma greatly lessens the need for more invasive treatments and may avoid surgery.

Treatment Options

For mild to moderate neuromas, treatment options may include:

• Padding to provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking
• Icing the affected area to reduce swelling
• Braces and/or Custom orthotics to prove arch support in order to reduce pressure and compression on the nerve
• Activity modifications to avoid repetitive pressure on the neuroma
• Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels
• Oral nonsteroidal anti-inflammatory drugs such as ibuprofen, may be recommended to reduce pain and inflammation
• Injection of corticosteroid into the affected area to reduce inflammation and help with pain.

For severe neuromas

Surgery may be considered in patients who have not responded adequately to non-surgical treatments. Your podiatrist will determine the approach that is best for your condition. The length of the recovery period will vary, depending on the procedure performed.

Long term measures to help keep your symptoms from returning. These include appropriate footgear and modification of activities to reduce the repetitive pressure on the foot.