Morton's Neuroma

What is a Neuroma?

A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton's neuroma, which occurs between the third and fourth toes.

It is sometimes referred to as an intermetatarsal neuroma. “Intermetatarsal” describes its location in the ball of the foot between the metatarsal bones. Neuromas may also occur in other locations in the foot.

The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage.

Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is 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 - bunions, hammertoes, flatfeet, or more flexible feet - are at higher risk for developing a neuroma.

Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or court sports . An injury or other type of trauma to the area may also lead to a neuroma.

Diagnosis

A Morton's neuroma is typically diagnosed through a physical exam: pressing on the space between the metatarsal heads to reproduce the burning or tingling pain, and squeezing the forefoot to check for a palpable click (Mulder's sign). Ultrasound or MRI can confirm the diagnosis and size of the neuroma when the exam findings are unclear.

Treatment Options

Conservative treatment, such as wider shoes, metatarsal pads, activity modification, and injections, resolves symptoms for many patients. When conservative care isn't enough, surgical removal of the thickened nerve tissue is an option, typically performed through a small incision on the top of the foot. The American Academy of Orthopaedic Surgeons notes that surgery is generally considered once symptoms have persisted 3 to 6 months despite conservative care, and reports long-term relief in approximately 80-95% of surgical patients. StatPearls describes the underlying process as nerve compression and tissue degeneration rather than a true tumor, most often occurring between the third and fourth metatarsal heads.

When to See a Surgeon

If burning, tingling, or numbness between the toes persists despite shoe changes and conservative care, an evaluation can confirm the diagnosis and discuss treatment options before the nerve damage becomes permanent.