What are the other Names for this Condition? (Also known as/Synonyms)
- Interdigital Neuroma
- Morton’s Metatarsalgia
- Plantar Neuroma
What is Morton’s Neuroma? (Definition/Background Information)
- Morton’s Neuroma is a painful, clinical condition caused by thickening of tissue that surrounds the nerve, most frequently between the third and fourth toe, causing discomfort in the ball of the foot
- The discomfort may even result in burning sensation, or one may feel a foreign body presence between the third and fourth toes, especially when standing
- Neuroma indicates a benign tumor of a nerve, but Morton's Neuroma is not actually a tumor
Who gets Morton’s Neuroma? (Age and Sex Distribution)
- Women are more likely to be affected by Morton’s Neuroma than men
- Men or women of any age maybe affected; however, individuals in the age group 40-50 years have an increased risk
What are the Risk Factors for Morton’s Neuroma? (Predisposing Factors)
There are numerous risk factors attributed to Morton’s Neuroma, which include:
- Certain sporting activities that result in high impact stress to the nerves, under the ball of the foot
- Athletic activities, including sports such as rock-climbing, skiing, soccer, and tennis, which requires one to wear tight shoes
- Wearing high heels
- Presence of foot deformities is postulated as a reason for the development of Morton’s Neuroma. These include hammertoes, flat feet, and bunions
- Any tight-fitting or ill-fitting shoe can cause constant stress on the soles of the feet, and toes causing Morton’s Neuroma.
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
What are the Causes of Morton’s Neuroma? (Etiology)
- The exact reason why an individual is affected by Morton’s Neuroma, is not yet precisely established
- Various theories have been proposed for the cause of Morton’s Neuroma, and these include: It is caused in response to injuries, constant irritation, and pressure to the tissue surrounding the digital nerve causing compression of the nerve between the third and fourth toe
What are the Signs and Symptoms of Morton’s Neuroma?
All the signs and symptoms of Morton’s Neuroma are focused around the third, fourth toes, and ball of the foot. These include:
- Foreign body sensation between the third and fourth digits of the foot, especially while standing
- Sharp pain in the space between the toes
- Feeling of numbness and tingling
- Burning sensation over the ball of the foot radiating to the toes
One has to remember however, that Morton’s Neuroma is not a tumor of the nerve, but a thickening of the tissues surrounding the nerve that causes the symptoms.
How is Morton’s Neuroma Diagnosed?
A diagnosis of Morton’s Neuroma would include:
- Physical examination: No obvious palpable swelling is noted on exam. This examination also helps rule out obvious deformities, local infections, and plantar warts
- X-rays of the feet are done to rule out stress fractures, bone tumors, and infections (like osteomyelitis)
- Ultrasound scans may reveal thickening of the tissue surrounding the digital nerve
- MRI scan helps visualize the thickened soft tissues around the nerve
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
What are the possible Complications of Morton’s Neuroma?
No significant complications have been identified with Morton’s Neuroma. It depends on the extent of thickness of the tissue, causing the symptoms. However, if the condition is left untreated, it may cause significant pain/discomfort leading to restricted activities of daily living.
How is Morton’s Neuroma Treated?
Treatment is based on the intensity of the symptoms. The treatment measures for Morton’s Neuroma include:
- Use of orthotics like footpads and arch supports are recommended. These help in reducing the stress and pressure on the ball of foot.
- Avoiding high heels and ill-fitting shoes also help in relieving pain and easing the symptoms
- Steroid injections and non-steroidal anti-inflammatory medications like Advil (Ibuprofen, Motrin), Aleve and other prescription medications, help relieve the pain and inflammation
- Cryogenic Neuroablation: Cryogenic neuroablation is a minimally invasive intervention technique; in which a cold probe is inserted into the affected region, to aid in pain reduction. The main advantage of this procedure is in the immediate relief that it provides. However, the effects do not last long, and since the results are temporary, permanent procedures may be necessary in some cases at a later stage
- Decompression Surgery: This procedure consists of reducing the pressure around the affected nerve by removing the thickened tissue. Decompression surgery is a more invasive technique, but the results are beneficial and could be a permanent solution
- Neurectomy: This is only used as a last resort; where the entire nerve tissue is removed in this procedure. This can cause significant side effects, such as loss of nerve function and numbness in the toes
How can Morton’s Neuroma be Prevented?
Adults, especially those in the ‘high-risk’ age category, have to be generally careful while performing any physical activity. Some simple techniques that help prevent Morton’s Neuroma include:
- Avoiding ill-fitting shoes
- Reduce, if not completely avoid, the usage of high heels
- Reduce the pressure in your shoes during sporting activities by wearing appropriate orthotics (shoe inserts) and using roomier shoes may help in preventing Morton’s Neuroma
What is the Prognosis of Morton’s Neuroma? (Outcomes/Resolutions)
- 80% of individuals with Morton’s Neuroma have benefitted from a combination of roomier, more comfortable shoes, non-steroidal anti-inflammatory medications, custom fit foot orthotics and steroid injections
- Surgery also provides permanent relief. The condition may recur if there is persistent stress to the foot
Additional and Relevant Useful Information for Morton’s Neuroma:
The following DoveMed website link is a useful resource for additional information: