What Is Morton’s Neuroma?
Morton’s neuroma is a painful thickening of a nerve between the toes, most commonly affecting the nerve between the third and fourth toes.
Despite its name, Morton’s neuroma is not a tumor. It is a benign enlargement of the nerve associated with irritation, compression, and scarring, or fibrosis, of the nerve tissue.
The condition occurs more frequently in women and is commonly seen in adults. In some patients, Morton’s neuroma may affect both feet.
What Causes Morton’s Neuroma?
The exact cause of Morton’s neuroma is not completely understood. The condition develops when a nerve running between the metatarsal bones becomes repeatedly compressed or irritated.
Mechanical Factors
Several mechanical factors may contribute to compression of the nerve, including:
- Pressure from the metatarsal bones on either side of the nerve
- Compression from the deep transverse metatarsal ligament, which runs across the nerve
- Excessive movement between the metatarsal bones
- Repeated stress and microtrauma affecting the nerve over time
Risk Factors
Several factors may increase the likelihood of developing Morton’s neuroma:
- Footwear: High heels and tight or pointed shoes can place additional pressure on the forefoot and squeeze the toes together.
- Gender: Morton’s neuroma occurs more frequently in women.
- Body weight: Higher body mass may increase pressure on the forefoot.
- Age: The condition becomes more common with age.
- Activities: Running, tennis, and other activities that repeatedly place stress on the forefoot may contribute to nerve irritation.
What Are the Symptoms of Morton’s Neuroma?
Symptoms of Morton’s neuroma often develop gradually and may become more noticeable during walking or other weight-bearing activities.
Pain and Sensation
Symptoms may include:
- Burning, sharp, or shooting pain in the ball of the foot, commonly between the third and fourth toes
- Pain that radiates into the affected toes
- Numbness or tingling in the toes
- Electrical or shooting sensations
- Cramping or discomfort in the forefoot
What Can Make Symptoms Worse?
- Walking, particularly for prolonged periods
- Tight or narrow footwear
- High heels
- Weight-bearing activities
What Can Reduce Symptoms?
- Rest
- Removing restrictive footwear
- Gently massaging the foot
- Wearing wider and more comfortable shoes
Non-Surgical Treatment Options
Treatment typically begins with conservative measures designed to reduce pressure on the affected nerve and relieve irritation.
Footwear Modifications
Changing footwear can help reduce pressure across the forefoot. Options may include:
- Shoes with a wider toe box
- Supportive shoes with appropriate cushioning
- Avoiding narrow or pointed footwear
- Avoiding or reducing the use of high heels
Orthotic Devices
Orthotic devices may be used to redistribute pressure across the forefoot and reduce compression around the affected nerve. These may include:
- Metatarsal pads positioned behind the ball of the foot
- Custom or prefabricated shoe inserts with arch support
- Pads designed to reduce pressure around the affected area
Activity Modification
Activities that aggravate symptoms may need to be temporarily reduced or modified. Lower-impact activities such as swimming or cycling may place less stress on the forefoot. A gradual return to normal activities may be considered as symptoms improve.
Injections
Corticosteroid injections may be considered to provide temporary relief from pain and inflammation in selected patients. The potential benefits and risks of injections should be evaluated for each individual patient.
Physical Therapy
Physical therapy may include:
- Stretching exercises for the calf and foot
- Strengthening exercises
- Manual therapy techniques
When symptoms continue despite appropriate conservative treatment, surgical options may be considered.
Surgical Treatment
When Morton’s neuroma symptoms persist despite appropriate non-surgical treatment, surgery may be considered.
Traditionally, one surgical approach has been neurectomy, which involves removing the affected portion of the nerve. While this procedure may relieve symptoms, removing the nerve can also have potential drawbacks.
Considerations With Nerve Removal
Potential considerations associated with neurectomy include:
- Stump neuroma formation: A painful neuroma may develop at the cut end of the nerve.
- Permanent numbness: Removing the nerve can result in permanent numbness in the toes supplied by that nerve.
- Persistent pain: Some patients may continue to experience forefoot pain after surgery.
- Scar-related discomfort: Surgical scarring may contribute to discomfort in some patients.
- Recurrent symptoms: Additional treatment may occasionally be required if symptoms persist or return.
- Ongoing pain: Some patients may experience continued pain following nerve surgery.
Because of these considerations, nerve-sparing surgical approaches may also be considered. These procedures are designed to address compression around the nerve without removing the nerve itself.
Nerve-Sparing and Minimally Invasive Treatment
A nerve-sparing approach to Morton’s neuroma focuses on creating additional space around the affected nerve and reducing the structures that may be contributing to compression.
Depending on the individual condition, this may involve a metatarsal osteotomy combined with release of the ligament contributing to nerve compression.
How Does It Work?
The procedure is designed to reduce pressure around the affected nerve through two main components.
1. Metatarsal Osteotomy
A controlled cut is made in the appropriate metatarsal bone to allow the position of the bone to be adjusted.
This may:
- Increase the space available for the affected nerve
- Reduce pressure between the metatarsal bones
- Help decompress the irritated nerve
When performed using minimally invasive techniques, the procedure is completed through small incisions and may be performed with imaging guidance to assist with accurate positioning.
2. Ligament Release
The deep transverse metatarsal ligament is a band of tissue that runs across the forefoot and over the affected nerve.
Releasing this ligament can create additional space around the nerve and reduce compression from above.
By reducing pressure around the nerve, the procedure is intended to address the mechanical compression associated with Morton’s neuroma while preserving the nerve.
The Role of the Fourth Metatarsal
In selected cases, an osteotomy of the fourth metatarsal may be used as part of the surgical treatment of Morton’s neuroma.
The goal is to increase the space around the affected nerve while limiting the amount of surgical intervention required. The specific surgical approach depends on the location of the neuroma, the structure of the foot, the severity of symptoms, and other individual factors.
Potential Advantages of a Nerve-Sparing Approach
Compared with removing the affected nerve, a nerve-sparing approach is designed to preserve the nerve while addressing the surrounding compression.
Preserving the Nerve
Potential advantages include:
- Preserving sensation in the affected area
- Avoiding removal of the nerve
- Avoiding the risk of stump neuroma associated with cutting the nerve
- Allowing the nerve to remain intact after decompression
Minimally Invasive Technique
When appropriate, minimally invasive techniques may offer:
- Smaller surgical incisions
- Reduced disruption of surrounding soft tissues
- Smaller surgical scars
- A focused approach to the area of compression
Addressing Nerve Compression
Rather than removing the affected nerve, decompression procedures are intended to increase the space around it.
This may:
- Reduce pressure on the nerve
- Increase the space between the surrounding structures
- Address mechanical factors contributing to nerve irritation
- Preserve the nerve while treating the area of compression
What to Expect: The Procedure and Recovery
The surgical approach and recovery process for Morton’s neuroma depend on the procedure performed and the individual patient.
When a minimally invasive nerve-sparing procedure is appropriate, treatment is designed to reduce compression around the affected nerve while limiting disruption to the surrounding tissues.
The Procedure
Morton’s neuroma surgery may be performed as an outpatient procedure, allowing the patient to return home the same day.
Depending on the surgical approach, the procedure may involve:
- Small surgical incisions
- Metatarsal osteotomy when indicated
- Release of the ligament contributing to nerve compression
- Imaging guidance to assist with accurate positioning
- Appropriate anesthesia based on the procedure and individual patient
The specific surgical technique is selected according to the location of the neuroma, the anatomy of the foot, the severity of symptoms, and other individual factors.
Early Recovery
Following surgery, a surgical shoe or walking boot may be used to protect the foot during the initial healing period.
Small dressings are placed over the surgical incisions, and post-operative instructions are provided based on the procedure performed.
Recovery varies from patient to patient and depends on factors such as the surgical technique, the extent of treatment, individual healing, and activity level.
Returning to Activity
The return to normal footwear, daily activities, exercise, and higher-impact activities is determined by healing and the procedure performed.
Follow-up evaluation allows the progress of healing to be monitored and activity to be increased appropriately.
Patients should follow their individual post-operative instructions and avoid advancing activity beyond the recommended level during recovery.
Treatment Tailored to the Individual Patient
Morton’s neuroma can cause persistent pain, burning, tingling, or numbness in the forefoot and toes. Treatment depends on the severity and duration of symptoms, the anatomy of the foot, and the response to previous conservative care.
Non-surgical treatment is generally considered first. When symptoms continue despite appropriate conservative treatment, surgical options may be evaluated.
Depending on the individual condition, treatment may include nerve decompression, ligament release, metatarsal osteotomy, nerve removal, or another appropriate surgical approach.
The goal of treatment is to address the source of symptoms while selecting an approach appropriate for the individual patient’s condition and functional needs.
Your Surgeon for Morton’s Neuroma Treatment on Long Island
Kristian Efremov, MD, PhD, is a fellowship-trained orthopedic foot and ankle surgeon. He evaluates and treats Morton’s neuroma for patients across Nassau and Suffolk County at NYU Langone Ambulatory Care East Meadow, 1530 Front Street, Suite 200, East Meadow, NY 11554.
Options covered on this page range from footwear changes, orthotics and injections to a nerve-sparing, minimally invasive approach using a metatarsal osteotomy and ligament release. The right option depends on your exam, imaging and goals.
Dr. Efremov completed his foot and ankle surgery fellowship at New England Baptist Hospital and is a Clinical Assistant Professor in the Department of Orthopedic Surgery at NYU Grossman Long Island School of Medicine.
To request an appointment, call (516) 324-7500 or read more about Dr. Efremov.
Medical Disclaimer. The information provided on this website is intended for general educational and informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare professional regarding any medical condition, symptoms, or treatment options.