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Morton's neuroma — also called interdigital neuroma, intermetatarsal neuroma or forefoot neuroma — is a benign swelling along one of the nerves that carry sensations from the toes. This swelling, which is formed by the buildup of fibrous tissue, initially develops as a way to cushion the sensory nerve against unusual irritation from nearby bones and ligaments inside the foot. In time, however, the fibrous cushion itself becomes so large that it surrounds, compresses and eventually damages the sensory nerve inside it. This produces a burning pain, numbness, tingling and other abnormal sensations in the toes.
Morton's neuroma usually develops between the third and fourth toes or between the second and third toes. Other locations are rare. The condition is especially common in obese women between the ages of 30 and 60 who wear high-heeled shoes with narrow toes. High, narrow shoes tend to shift the bones of the feet into an abnormal position that compresses and irritates nearby nerves. This increases the risk that a neuroma will form.
It's unusual (less than 1 percent) to have a Morton's neuroma in both feet simultaneously. It's even more unusual (less than 0.1 percent) to have two neuromas in the same foot simultaneously.
Morton's neuroma usually causes a burning pain, numbness or tingling in the area of the third and fourth toes (less often, the second and third toes). In some cases, there may also be the sensation of a lump, a fold of sock or a "hot pebble" between the toes.
Typically, the pain of Morton's neuroma temporarily subsides when the patient takes off her shoes, flexes her toes and rubs her aching feet.
What Your Doctor Looks For
Once you have described your symptoms, your doctor will probably ask questions about your shoes — the type of shoes you usually wear (sneakers, loafers, pumps, flats) and whether these shoes have narrow toes and/or high heels. To rule out other causes besides Morton's neuroma, your doctor will ask questions about your medical and orthopedic history, especially any history of arthritis, neuromuscular problems or previous injury to your foot or leg.
Your doctor will suspect that you have a Morton's neuroma based on your description of the quality and location of your foot pain. To confirm the diagnosis, your doctor will perform a physical examination. This examination will include:
Once the physical examination is complete, your doctor can usually diagnose Morton's neuroma without additional testing. However, when the diagnosis is in doubt, he or she may order magnetic resonance imaging (MRI) or high-resolution ultrasound of your foot to visualize the neuroma. However, some neuromas are too small to be visualized by MRI or ultrasound. Because Morton's neuroma doesn't appear on standard foot X-rays, X-rays are used primarily to rule out other illnesses (that do show up on X-rays) rather than to confirm the presence of a Morton's neuroma.
Morton's neuroma is a long-term condition that will not disappear on its own. Your symptoms may wax and wane depending on the type of shoe you wear and how much time you spend on your feet. Local pain and discomfort may ease temporarily with conservative treatment.
It is not always possible to prevent Morton's neuroma. However, you can probably reduce your risk by wearing shoes that have low heels and ample toe space.
Also, because Morton's neuroma is especially common in obese individuals, you may help to prevent the condition by maintaining a healthy weight that doesn't overstress the bones and ligaments of your feet.
If you suffer from a painful Morton's neuroma, your doctor will usually begin your treatment with conservative therapies, including:
If your pain persists in spite of this conservative treatment, your doctor may recommend surgery to remove the neuroma. This surgery, which can often be performed under a local anesthetic, removes a portion of the affected nerve along with the neuroma, resulting in permanent numbness between the toes.
Make an appointment to see your family doctor, orthopedic surgeon or podiatrist if you have symptoms of Morton's neuroma, or if you have any other type of foot pain that interferes with your ability to walk comfortably.
Because only 20 percent to 30 percent of patients with Morton's neuroma respond to conservative treatment, many eventually opt for a surgical cure. Fortunately, surgical treatment has a success rate of 76 percent to 93 percent.