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Morton neuroma

Morton neuroma is an injury to the nerve between the toes, which causes thickening and pain. It commonly affects the nerve that travels between the third and fourth toes.

Causes

The exact cause is unknown. Doctors believe the following may play a role in the development of this condition:

Morton neuroma is more common in women than in men.

Symptoms


  • Tingling in the space between the third and fourth toes
  • Toe cramping
  • Sharp, shooting, or burning pain in the ball of the foot and sometimes toes
  • Pain that increases when wearing shoes or pressing on the area
  • Pain that gets worse over time

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

Exams and Tests

Your health care provider can usually diagnose this problem by examining your foot. 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 rule out 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 doctor may recommend any of the following:

  • Padding and taping the toe area
  • Shoe inserts
  • Changes to footwear, for example wearing shoes with wider toe boxes or flat heels
  • Anti-inflammatory medicines taken by mouth or injected into the toe area
  • 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 inflammed 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 about 85% of cases.

Possible Complications

Morton neuroma can make walking difficult. Persons with this foot condition may also have trouble with activities that put pressure on the foot, such as pressing the gas pedal while driving. It may hurt to wear certain types of shoes, such as high-heels.

When to Contact a Medical Professional

Call your health care provider if you have persistent pain or tingling in your foot or toe area.

Prevention

Avoid ill-fitting shoes. Wear shoes with a wide toe box or flat heels.

References

McGee DL. Podiatric procedures. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, PA: Saunders Elsevier; 2009:chap 51.

Scardina RJ, Lee SM. Morton neuroma. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2008:chap 85.

Updated: 4/16/2013

C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial Team.


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