Nerve Entrapment/ Neuroma


  • 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

  1. Neuroma commonly develops between the 3rd and 4th toes.
  2. Numbness or a burning sensation extending into the toes.
  3. Pain is isolated to just one or two toes.
  4. A feeling that something is inside the ball of the foot.
  5. Squeezing the front of the foot together can exacerbate symptoms.
  6. Symptoms begin gradually and over time, they progressively worsen.

Tests and Imaging

  1. Range-of-motion tests will rule out arthritis or joint inflammation.
  2. Lateral forefoot pressure may produce a painful “click” as the nerve is compressed.
  3. Ultrasound will differentiate neuroma from intermetatarsal bursitis (though they may be concurrent)
  4. Plain x-rays of the foot may demonstrate that one or more of the metatarsals are long.

Immediate Treatment

  1. Advise use of comfort shoe wear.
  2. Advise period of activity modification to decrease or eliminate activities which maybe exacerbating the patient’s symptoms.
  3. Guided injections can help decrease inflammation associated with the nerve.

Possible Referral

  1. Podiatry for padding, insoles or orthotics to decrease the load through the involved area of the plantar forefoot.
  2. Surgery for nerve resection, radio frequency ablation,or release tissue around the nerve after failure of nonoperative management