Morton’s Neuroma - Finding Relief from Nerve Pain in Your Feet

Ever feel like there’s a stone in your shoe, but when you check, there’s nothing there? That sharp, burning sensation or the feeling of numbness between your toes might be a sign of Morton's neuroma.

This often-overlooked nerve condition affects thousands of people, especially those with active lifestyles. But what exactly causes it, and why might you be experiencing it now?

In this blog, we look more closely into the symptoms, causes, and most importantly, how to find relief.

What is Morton’s Neuroma?

Morton’s Neuroma, also known as intermetatarsal neuroma, is a painful condition that affects the ball of the foot, most commonly between the third and fourth toes.

It was first documented by an American surgeon called Thomas George Morton in 1876!It is not actually a tumour but rather a thickening of the tissue surrounding the interdigital nerves, which can lead to nerve irritation and compression.

This condition results in sharp, burning pain, numbness, and tingling in the foot and toes which can be quite severe and make walking or running very painful.

Who Gets Morton’s Neuroma and Why?

Morton’s Neuroma is a relatively common foot condition which tends to affect adults, especially women between the ages of 30 and 60. It rarely affects both feet, certainly not at the same time.

Several factors can increase the likelihood of developing this condition:

Footwear

Wearing tight, high-heeled, or narrow shoes that squeeze the toes can significantly increase pressure on the forefoot. This compression may contribute to nerve irritation over time.

Foot Structure

People with certain foot types, such as flat feet, high arches, or bunions, are more prone to developing Morton’s Neuroma. These structural abnormalities can alter the weight distribution on the feet, placing extra stress on the metatarsal area.

Repetitive Trauma

Individuals who engage in high-impact activities, such as dancing, running, or sports that involve frequent pressure on the forefoot like tennis or basketball, are at a higher risk of developing this condition due to repetitive microtrauma to the nerve.

Pre-existing Conditions

Conditions such as hammertoes, where the toes bend abnormally, can cause additional pressure on the nerves, contributing to the development of Morton’s Neuroma.

Symptoms of Morton’s Neuroma

The primary symptom of Morton’s Neuroma is pain in the ball of the foot. This pain is often described as sharp, burning, or akin to walking on a pebble. Other key symptoms include:

• Numbness or tingling in the toes adjacent to the affected area.
• Sensation of fullness between the toes or at the ball of the foot.
• Worsening of pain with activity, especially walking or running.
• Pain relief when removing tight shoes or massaging the foot.

Symptoms tend to fluctuate, often worsening during periods of activity and improving when resting or wearing wider, more comfortable footwear.

Diagnosis of Morton’s Neuroma

Diagnosing Morton’s Neuroma typically begins with a thorough physical examination by a healthcare professional, who will assess the patient's medical history and symptoms. During the examination, the clinician may:

• Palpate the area between the metatarsal heads to reproduce pain and detect any palpable masses (Mulder’s sign).
• Perform the squeeze test, in which squeezing the foot from the sides can elicit a clicking sensation (Mulder’s click) and pain, confirming the presence of the neuroma.

To confirm the diagnosis and rule out other possible conditions such as stress fractures or arthritis, imaging studies may be used:

• Ultrasound: High-frequency sound waves provide a clear image of soft tissues, allowing clinicians to visualize the neuroma’s size and location.
• Magnetic Resonance Imaging (MRI): Though more costly, MRI offers detailed images of both bones and soft tissues and is often used to confirm the diagnosis when symptoms are severe, or the ultrasound findings are inconclusive.

What is the Best Treatment for Morton’s Neuroma?

Treatment for Morton’s Neuroma depends on the severity of the condition and how long symptoms have been present. The goal is to relieve nerve irritation and reduce pressure on the affected area. Treatment options range from conservative approaches to more invasive interventions:

Conservative Treatment for Morton’s Neuroma

• Footwear modifications: The first step in managing Morton’s Neuroma is switching to shoes with a wider toe box, low heels, and good arch support. This can alleviate pressure on the nerve.
• Orthotic devices: Custom or over-the-counter orthotics can help redistribute weight across the foot, reducing pressure on the affected nerve.
• Padding: Metatarsal pads can be placed inside the shoe to relieve pressure and cushion the ball of the foot.
• Shockwave therapy: This is an emerging non-invasive treatment for Morton’s Neuroma, which involves delivering high-energy sound waves to the affected area. This therapy is believed to reduce pain and inflammation by promoting tissue healing, improving blood flow, and potentially regenerating damaged nerve tissues. Recent studies suggest that shockwave therapy can offer significant symptom relief for patients with Morton’s Neuroma, especially when conservative treatments have been ineffective. While research on its long-term efficacy is still ongoing, it has shown promise as a safe and effective alternative to more invasive procedures.
• Physiotherapy: Stretching and strengthening exercises, alongside techniques like ultrasound therapy, can improve foot mechanics and alleviate symptoms.

2.      Medications and Injections for Morton’s Neuroma

• Anti-inflammatory medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to reduce pain and inflammation.
• Corticosteroid injections: Steroid injections can provide significant relief by reducing inflammation around the neuroma. However, repeated use of steroids may weaken the tissues and should be approached cautiously.
• Alcohol sclerosing injections: These injections aim to chemically destroy the nerve and offer pain relief. Research has shown that sclerosing injections can be a minimally invasive, effective treatment option.

Will Morton’s Neuroma Ever Go Away?

Morton’s Neuroma does not typically resolve on its own without some form of intervention. However, conservative treatments, such as footwear changes, orthotics, and physiotherapy can help manage symptoms and prevent the condition from worsening.

With appropriate care, many patients find significant relief, and their symptoms may subside. Early diagnosis and treatment increase the chances of a favourable outcome.

For patients who experience chronic symptoms, minimally invasive treatments like injections or surgery may be necessary to provide lasting relief.

Surgical Treatment for Morton’s Neuroma

Surgery for Morton’s Neuroma is a very safe and successful procedure, and is often the best long term solution.

Evidence shows that surgical intervention can offer significant and lasting relief, particularly for patients who experience debilitating pain that impacts daily function. Studies suggest that around 80-90% of patients who undergo a neurectomy report substantial or complete symptom relief post-surgery.

The procedure effectively removes the portion of the nerve causing discomfort, reducing the painful sensations between the toes. Research also indicates that surgical outcomes are long lasting, with most patients experiencing sustained relief even years after the procedure.

Recovery times vary, but many patients return to their normal activities within weeks to a few months, depending on the complexity of the case and adherence to post-operative care. For those who have exhausted non-surgical options, surgery remains a highly effective treatment for restoring foot comfort and functionality.

The two common surgical options are:

• Neurectomy: Removal of the affected nerve. This procedure provides permanent relief but may lead to numbness in the toes.
• Decompression surgery: This technique involves releasing tight structures around the nerve to relieve pressure.

What Happens If You Don’t Treat Morton’s Neuroma?

If Morton’s Neuroma is left untreated, the pain and discomfort are likely to worsen over time. This can lead to several complications:

• Chronic Pain: As the nerve continues to be compressed, the pain can become more severe and may persist even during rest.
• Altered Gait: To avoid putting pressure on the affected foot, individuals may adjust their gait, potentially leading to secondary issues like knee, hip, or lower back pain.
• Reduced Mobility: Chronic discomfort may make it difficult to walk or engage in physical activities, affecting the individual’s overall quality of life.
• Permanent Nerve Damage: Prolonged compression of the nerve can result in irreversible damage, potentially leading to permanent numbness or altered sensation in the toes.

Recent Research on Morton’s Neuroma

Recent studies have focused on understanding the most effective treatment approaches for Morton’s Neuroma. One notable area of research is the use of alcohol sclerosing injections. A 2022 study demonstrated that patients receiving a series of alcohol injections had significant improvements in pain and functional outcomes compared to conservative treatments alone.

Additionally, a study published in 2023 explored the role of shockwave therapy for Morton’s Neuroma, suggesting that this non-invasive approach could reduce pain and inflammation by promoting tissue healing and nerve regeneration.

Conclusion

Morton’s Neuroma is a painful condition that can significantly impact daily life if left untreated. Fortunately, a variety of treatment options exist, ranging from conservative approaches to more invasive procedures. Early diagnosis and intervention are key to managing symptoms and preventing long-term complications. Whether through footwear changes, orthotics, injections, or surgery, patients have a high likelihood of achieving relief and returning to the activities they love.

References

1. Masala, S., Fiori, R., Raguso, M., et al. (2022). "Percutaneous alcohol injection in the management of Morton’s neuroma: A review of outcomes." Journal of Foot & Ankle Research 15(4), 321–326.
2. Zhu, M., Yang, L., Li, J., et al. (2023). "Efficacy of alcohol sclerosing injections versus corticosteroid injections for Morton’s neuroma: A randomized trial." International Journal of Foot & Ankle Surgery, 9(1), 11–17.
3. Ahmed, M., et al. (2022). "Sclerosing injections for treating Morton’s neuroma: A systematic review and meta-analysis." European Journal of Orthopaedic Surgery & Traumatology, 32(5), 819–825.
4. Koo, Y., Lee, C. H. (2023). "The effects of extracorporeal shockwave therapy in patients with Morton’s Neuroma: A pilot study." Journal of Rehabilitation Research and Development, 60(2), 15-20.