Morton’s Neuroma

In order to understand this condition, it is important to understand the anatomy and function of the foot. Please read Foot Pain Info’s section on basic foot anatomy. For additional background information on the biomechanics of the foot please read Foot Pain Info’s section on basic foot and ankle biomechanics.

What is Morton’s neuroma?

The nerves that supply feeling to space between the toes are called interdigital nerves. These nerves run parallel and between the long metatarsal bones of the foot. A Morton’s neuroma (also called an interdigital neuroma) is the term used to describe an area of thickening around an interdigital nerve. The space between the third and fourth toes is the most common area for a Morton’s neuroma to develop.

Nerves of the Forefoot

What does Morton’s neuroma feel like?

People who have a Morton’s neuroma often complain of pain or numbness in the space between their third and fourth toes. The pain is worsened with activities like walking or running. In some cases, a small, painful lump can be felt between the third and fourth metatarsal bones. People often report the sensation of a “rock in their shoe”. Sideways compression of the foot may also produce a painful click, as the thickened nerve slips between the metatarsal bones. In addition to pain, there can be numbness in the space between the third and fourth toes and this numbness can either be constant or intermittent. Poor footwear, particularly high-heeled shoes or shoes with a narrow toe area can make a Morton’s neuroma worse. People with a Morton’s neuroma often remove their shoe and massage their foot to relieve the discomfort.

What causes Morton’s neuroma?

Anything that causes irritation of the interdigital nerves can cause a Morton’s neuroma to develop. Overuse combined with poor footwear is a common cause. Poor foot biomechanics such as excessive pronation (feet rolled inward) and loss of the transverse (metatarsal) arch are other factors that have been associated with the development of a Morton’s neuroma.

Can Morton’s neuroma be detected on X-rays?

A Morton’s neuroma cannot be detected on x-ray. Therefore, although x-rays are often done to rule out bony injuries these x-rays are usually normal. Occasionally, bone scans, ultrasounds and MRI scans are performed to rule out other possible causes of forefoot pain such as a metatarsal stress fracture, arthritis of the MTP joints, or injury to the metatarsal heads i.e. osteochondrosis.

What is the treatment for Morton’s neuroma?

The treatment for a Morton’s neuroma should be individualized. The most important first step in the treatment (and prevention) of a Morton’s neuroma is to wear proper shoes and avoid shoes with high heels. Further treatment may include relative rest from activity or prolonged standing, medications to reduce inflammation and pain, stretching and strengthening exercises, a pad to support the metatarsal arch, or custom shoe orthotics. If these measures are not successful a cortisone injection may be necessary. Surgery to remove the thickened area of the nerve is a final option.

What other information is available on Morton’s neuroma?

Foot Pain Info’s links section has additional information on this topic. Links have been provided to other websites as well as online medical journals. Visit Joint Pain Info for information on other joint injuries and problems.