Morton's Neuroma

Definition

A Morton’s Neuroma is a benign tumor of a nerve. Morton’s Neuroma is not actually a tumor, but a thickening of the tissue that surrounds a nerve leading to the toes. It occurs as the nerve passes under the ligament connecting the toe bones (metatarsals) in the forefoot. The nerve becomes sandwiched between the bones in the foot. A Morton’s Neuroma most frequently develops between the third and fourth toes but is also quite common between the second and third toes.

Causes of Morton’s Neuroma

Morton’s Neuroma develops in response to irritation, trauma or excess pressure on the foot. Shoes that are too tight, have too little cushion, and high heels can all contribute to the development of Morton’s Neuroma. These shoes are known to aggravate the condition by compressing the toe bones and pinching the nerve. Also because of these shoe choices, Morton’s Neuroma is 10 times more common in women than in men.

Signs/Symptoms of Morton’s Neuroma

Typically, a lump or redness over the affected area will not be present. The most common sign/symptom of Morton’s Neuroma is the feeling of walking on a “bunched up sock” or a marble. In addition a Morton’s Neuroma will cause a tingling/numbing sensation in the toes and a burning sensation in the ball of the foot which can radiate to the toes. Because a Morton’s Neuroma is a nerve tumor, the neurological impulse sent back to the brain varies widely.  Night pain from a Morton Neuroma is rare.

Diagnosis of Morton’s Neuroma

During the examination, we will will test for a mass or a “click” between the bones in the foot. This test is called the “lateral squeeze test.” For this test we will squeeze the forefoot from side to side while applying pressure to the affected area between the toes. If a clicking sound or feeling is experienced, it is likely the patient has a Morton’s Neuroma. In addition to this test, we will examine the range of motion for all toes. Depending on the range of each toe, arthritis can be ruled out. An x-ray may be used to rule out a stress fracture of the metatarsal bones.

Treatment

Conservative Approaches
Initially we will recommend a change in footwear. A comfortable, well-fitting pair of shoes with wide toe-boxes, cushioning and lower heels are ideal. Making this change in footwear will allow the bones in the foot to spread out and reduce the pressure on the Morton’s Neuroma, giving it time to heal. In some cases, the shoe does not cause the Morton’s Neuroma. We may scan the patient’s foot to see if we can correct an imbalance using custom orthotics (custom shoe inserts). By prescribing custom orthotics we can align the foot so that pressure is taken off the Morton’s Neuroma.

A series of three weekly cortisone injections is also very effective in decreasing inflammation of the nerve, and will help bring some relief. In the case that cortisone injections are unsuccessful, we will use a new approach which involves injecting alcohol into the nerve. Three to seven injections of a four percent solution of dehydrated ethyl alcohol (drinking alcohol) is injected into the the Morton’s neuroma. In some cases physical therapy may be needed along with regularly taking oral anti-inflammatory medication.

Morton’s Neuroma Surgery
Conservative treatments are effective about 80% if the time. But in the case that a Morton’s Neuroma has gone untreated for longer than four to six months, the Neuroma can develop into a large fibrotic tumor. In this case, surgery is needed to remove the tumor. This surgery is a minor same-day, out-patient procedure and is done by making a one-inch incision on top of the foot. The tumor is then removed and patients will be back on their feet within two weeks. Recovery is typically swift and complications are unlikely.

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