Morton's neuroma

A neuroma is a noncancerous (benign) growth of nerve tissue that can develop in various parts of your body. Morton's neuroma occurs in a digital nerve in your foot, often between your third and fourth toes. The condition isn't a true tumor, but instead involves a thickening of the tissue around one of the digital nerves leading to your toes. It causes a sharp, burning pain in the ball of your foot. Your toes may also sting, burn or feel numb.

Also called plantar neuroma or intermetatarsal neuroma, Morton's neuroma may occur in response to irritation, injury or pressure — such as from wearing tight fitting shoes. But it may also occur for unknown reasons.

Treatments commonly involve changing footwear, resting your feet, and using arch supports or pads to help take pressure off the area. In some cases, your doctor may recommend anti-inflammatory drugs, a cortisone injection or even surgery.

Signs and symptoms

Typically, there's no outward sign of this condition, such as a lump. Instead, you may experience the following symptoms:

bulletA burning pain in the ball of your foot that may radiate into your toes
bulletTingling or numbness in your toes

At first, the pain may worsen when you wear tight or narrow shoes or engage in activities that place pressure on your feet. Over time, though, symptoms may last for days or weeks.

Causes

Doctors don't understand exactly what causes Morton's neuroma. The condition seems to occur in response to irritation, pressure or injury to one of the digital nerves that lead to your toes. The growth of thickened nerve tissue (neuroma) is part of your body's response to the irritation or injury.

Factors that appear to contribute to Morton's neuroma include:

bulletWearing high-heeled shoes or shoes that are tight or ill-fitting, including those that box in your feet and place pressure on your toes
bulletHigh-impact athletic activities, such as jogging, that subject your feet to repetitive trauma
bulletInjury to your foot

In some cases, Morton's neuroma may result from abnormal mechanics of the foot, caused by bunions, hammertoes, flatfeet or excessive flexibility. In some cases, there's no clear cause of pressure or irritation.

When to seek medical advice

It's best not to ignore any foot pain that lasts longer than a few days. If you experience a burning pain in the ball of your foot that's not improving, despite changing your footwear and modifying activities that may cause stress to your foot, see your doctor. He or she can examine your foot and determine whether Morton's neuroma or some other condition may be causing your pain. Early diagnosis and treatment can prevent the need for surgery.

Screening and diagnosis

Your doctor will ask about your symptoms and examine your foot. Because there's typically no outward sign of Morton's neuroma, your doctor will try to find a palpable, tender mass. There may also be a feeling of "clicking" between the bones of your foot. Your doctor may order an X-ray of your foot to rule out other foot problems.

Treatment

Treatment depends on the severity of your symptoms. Your doctor will likely recommend trying conservative approaches first. This may include resting your feet, changing to better-fitting shoes and taking over-the-counter medications to reduce inflammation and relieve pain.

If your pain is severe or persistent, or conservative approaches aren't working, you may need to turn to:

bulletCorticosteroid injection. Steroids are medications that reduce inflammation. An injection of a corticosteroid medication in the area of the neuroma may reduce pain. However, overuse of injected steroids can lead to a number of side effects, including weight gain and high blood pressure, so people usually receive only a limited number of injections.
bulletSurgery. Surgical removal of the growth may be necessary if other treatments fail to provide pain relief. Although surgery is usually highly successful, doctors often turn to surgery as a last resort, because the procedure removes both the neuroma and the nerve, which can leave permanent numbness in the affected toes.

Self-care

To help relieve the pain associated with Morton's neuroma and allow the nerve to heal, consider the following self-care steps:

bulletTake anti-inflammatory medications. Over-the-counter nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (Advil, Motrin, others), can reduce swelling and relieve pain.
bulletTry ice massage. Regular ice massage may help reduce pain. Freeze a water-filled paper cup or Styrofoam cup and roll it over the site of the pain three times a day.
bulletChange your footwear. Avoid high heels or tight shoes. Choose shoes with a broad toe box and extra depth.
bulletWear supports or pads (orthotic devices). Arch supports and foot pads fit inside your shoe and help reduce pressure on the nerve. Your doctor may prescribe a custom-made, individually designed shoe insert, which is molded to fit the contours of your foot. Or your doctor may recommend an over-the-counter metatarsal pad or bar, which you can position over the neuroma to relieve stress on the affected nerve.
bulletTake a break. For a few weeks, reduce activities such as jogging, aerobic exercise or dancing that subject your feet to high impact.