Summary
- Morton’s neuroma presents with pain in the forefoot, particularly in the “ball” of the foot due to irritation of the digital nerves as they pass across the metatarsophalangeal area.
- Causes include injury, activities that involve repetitive irritation to the ball of the foot such as running or court sports (also common in golfers), wearing shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box.
- People with certain foot deformities such as bunions, hammertoes, flatfeet, or more flexible feet are at higher risk for developing a neuroma.
Diagnostic tips
- Neuroma commonly develops between the 3rd and 4th toes.
- Numbness or a burning sensation extending into the toes.
- Pain is isolated to just one or two toes.
- A feeling that something is inside the ball of the foot.
- Squeezing the front of the foot together can exacerbate symptoms.
- Symptoms begin gradually and over time, they progressively worsen.
Tests and Imaging
- Range-of-motion tests will rule out arthritis or joint inflammation.
- Lateral forefoot pressure may produce a painful “click” as the nerve is compressed.
- Ultrasound will differentiate neuroma from intermetatarsal bursitis (though they may be concurrent)
- Plain x-rays of the foot may demonstrate that one or more of the metatarsals are long.
Immediate Treatment
- Advise use of comfort shoe wear.
- Advise period of activity modification to decrease or eliminate activities which maybe exacerbating the patient’s symptoms.
- Guided injections can help decrease inflammation associated with the nerve.
Possible Referral
- Podiatry for padding, insoles or orthotics to decrease the load through the involved area of the plantar forefoot.
- Surgery for nerve resection, radio frequency ablation,or release tissue around the nerve after failure of nonoperative management
