Morton's neuroma

Morton’s neuroma usually affects the plantar digital nerve between the third and fourth long bones (called metatarsal bones) in the middle of your foot. It's a result of irritation, injury or excessive pressure causing the nerve to enlarge. This leads to pain and numbness in the ball of your foot that spreads to your toes.

It’s at least four times more common in women than men, and usually affects people in their 40s and 50s.

Morton’s neuroma is often linked to wearing certain types footwear and activities, particularly ballet and running. You may find that the symptoms are worse when you’re moving your feet or wearing tight-fitting or high-heeled shoes.

It can affect one or both feet and also occur in the second and third toes. Morton’s neuroma symptoms can usually be alleviated without surgery. However, surgery may be necessary for severe symptoms or if previous treatment has been unsuccessful.

Anatomy of the foot

There are many nerves, muscles and ligaments that are found within your foot. One important structure is the plantar digital nerve. The plantar digital nerve is split into two branches, the medial (towards the inside of the body) and the lateral (towards the outside of the body). The medial plantar digital nerve branches further between the bones of your first four toes and supplies sensation to the skin of the first three and half of the fourth toe. Branches of the lateral nerve supply sensation to the skin of half of the fourth toe and the little toe.

If you have Morton's neuroma you’re likely to feel:

• An initial tingling sensation between your toes that develops into a more uncomfortable shooting pain (like having an electric shock)
• Numbness (loss of sensation) in your toes
• Pain when you walk – the longer you exercise, the worse the pain. You may also find that some footwear squashes your feet and makes it worse, and that the toe pain eases when you take off your shoes and massage your toes
• The sensation of a pebble under your foot
• A shooting, stabbing or burning pain

These symptoms can come and go, but you may find they last for a long time.

You should see your GP if you have any of the following:

• Severe pain in your feet that is stopping you from your normal activities
• Pain that’s worsening or keeps returning
• Pain that hasn’t improved after two weeks of home treatment
• Tingling or numbness in your foot
• Diabetes – foot problems can be more serious if you’re diabetic

Your GP is likely to be able to diagnose your condition after feeling your feet to find the tender spot and asking questions about your symptoms. They may ask to move your feet and other joints to rule out arthritis or joint inflammation.

Your GP may refer you to a foot specialist (podiatrist) or an orthotist, who provides devices to help mobility.

Occasionally, your GP may suggest either an MRI scan or ultrasound scan, X-ray or blood test to confirm the diagnosis and rule out other conditions.

The exact cause is unknown, but it can occur because of:

• Stress and irritation to the plantar digital nerve in your foot which has been squashed, stretched or rubbed
• Wearing narrow shoes (such as pointy toes) that compress the nerves running between the long bones in your foot
• Doing lots of activities that put pressure on your feet – such as running and rock climbing
• The growth of a fatty lump (lipoma) or the formation of a fluid-filled sac (bursa)
• Pre-existing foot problems – such as flat feet, high arches, bunions or hammer toes

The way the bones of the foot are arranged is also thought to contribute to the cause of Morton's neuroma. There is a very narrow space in between the bones of the second and third, and third and fourth toes for the nerves to pass along. This means the nerve between these bones is more likely to become compressed and irritated.

Morton’s neuroma won’t simply go away by itself. There are several non-surgical treatment options your GP or podiatrist may suggest and some of these are simple things you can do at home.

They may recommend:

• Resting your foot and massaging your toes
• Using an ice pack
• Different footwear – a wider toe area may help ease the pressure. You should avoid shoes with high heels, pointed toes and thin soles
• Orthotic devices – a soft pad insert for the ball of your foot or a custom-made device in your shoe to take the pressure off the painful area
• Painkillers – taking over-the-counter anti-inflammatories, such as ibuprofen
• Weight loss – if you're overweight or obese
• Local anaesthetic injections
• Steroid injections
• Cryosurgery or cryotherapy (freezing)
• Guided alcohol injection
• Radiofrequency ablation – heat treatment to the nerve

For around one in every three people, these treatments are enough to help them get better.

If the initial treatments don’t help and you’re in severe pain for some time, you may need to have surgery. Morton's neuroma excision is a surgical procedure which involves removing the part of the nerve which is causing you pain. It's usually performed through a small incision in the top, or the sole, of the foot. Excision will cause some permanent numbness in the skin between the toes affected, but this shouldn’t usually cause you any problems. Another type of surgery for Morton's neuroma is nerve decompression, this increases the space around the nerve to relieve symptoms.

Morton’s neuroma surgery is generally very successful. However, as with all operations, there’s a small risk of complications following these procedures. Although unlikely, you may develop an infection around the area of the incision. You may find that additional symptoms occur after incomplete surgery. If your Morton’s neuroma excision was incomplete and some nerve tissue remains, you may be left with a painful ‘stump’ neuroma. After nerve decompression surgery, there’s a risk that the nerve remains irritable too. Major problems after Morton’s neuroma surgery are rare.

Treatment outcomes for Morton's neuroma

Around one in three people find that changing footwear and using orthotic devices are enough to improve their symptoms. Out of those who choose to have surgery, around three out of four will find their symptoms relieved.

One in four who found their symptoms to be better after surgery may find that a problem occurs after some time. It’s important to wear the correct footwear and follow any advice given to you to prevent this from happening.

Does Morton’s neuroma go away?

Morton’s neuroma won’t simply go away by itself, but you may find that the symptoms come and go. Your GP or podiatrist can recommend some simple treatments for you to do at home to help with the pain. If these methods don’t help and you’re still in severe pain, you may need to have surgery.

What causes Morton’s neuroma to flare up?

The exact cause is unknown, but it can develop due to stretching and squashing the plantar digital nerve. This may be because of poor footwear, doing lots of exercises that put pressure on your feet, the growth of a lipoma or bursa, or other foot conditions.

How can I prevent Morton’s neuroma?

Wearing well-fitting shoes with a low heel and a wide area for your toes may help prevent the condition.

Is walking barefoot good for Morton's neuroma?

Walking barefoot won’t improve the condition, and you may actually find that it causes more pain as the foot is not as well supported as it is in the right shoes.

What is the best treatment for Morton's neuroma?

There are many treatment options for Morton’s neuroma. Your GP may suggest some home treatments for you to try and help with the pain first. Many people find these methods useful and around one in three people find that changing footwear and using orthotic devices are enough to improve their symptoms. If these home treatments are unsuccessful, then you may need surgery. Of those who choose to have surgery, around three out of four will find their symptoms relieved.

How do you massage Morton's neuroma?

You may find that regular ice massages will help reduce pain. To do this, freeze a water-filled paper or plastic cup and then roll the ice over the painful area.

What exercises can I do with Morton's neuroma?

Morton’s neuroma shouldn’t stop you from doing many activities and exercises, but you should always go at your own pace and stop when you feel pain. Your GP may also recommend some exercises and stretches to help with your pain.