A morton’s neuroma (or an “inter-digital” neuroma) is found between the toes of the foot, most commonly the third and fourth toes. It can also occur between the metatarsal bones (the long bones in the forefoot). It is basically an entrapped nerve, which becomes inflamed due to constant irritation from the surrounding bony structures.
Some say that this condition should not be called Morton’s neuroma as, in fact, it is not actually a neuroma. A neuroma is a non-cancerous (benign) tumour that grows from the fibrous coverings of a nerve. There is no tumour formation in Morton’s neuroma. The anatomy of the bones of the foot is also thought to contribute to the development of Morton’s neuroma. For example, the space between the long bones (metatarsals) in the foot is narrower between the second and third, and between the third and fourth metatarsals. This means that the nerves that run between these metatarsals are more likely to be compressed and irritated. Wearing narrow shoes can make this compression worse.
You may initially experience a tingling sensation in the space between your toes, which gets worse over time. This leads to cramp in your toes and a sharp shooting or burning pain on the ball of your foot or at the base of your toes. The pain is often worse when walking or wearing shoes that press on the affected area. This is caused by irritation of the nerve between your toe bones (metatarsal bones). The tingling will eventually lead to pain, which can get worse over time. You may also experience cramping of your toes. The pain is usually felt as a sharp shooting or burning pain on the ball of the foot or at the base of the toes, which is often made worse when you’re walking. Some people with Morton’s neuroma feel anxious about walking or even placing their foot on the ground. The pain is likely to be more intense if you wear tight shoes, so wearing shoes that have more room in the toe area can help. Rubbing your foot may also lessen the pain.
During the examination, your physician will feel for a palpable mass or a “click” between the bones. He or she will put pressure on the spaces between the toe bones to try to replicate the pain and look for calluses or evidence of stress fractures in the bones that might be the cause of the pain. Range of motion tests will rule out arthritis or joint inflammations. X-rays may be required to rule out a stress fracture or arthritis of the joints that join the toes to the foot.
Non Surgical Treatment
Conservative treatment for Morton?s neuroma involves footwear that allows your forefoot to spread. High-heeled shoes cause neuromas by squeezing and stretching your involved intermetatarsal nerve across the ball of your foot and should be avoided as often as possible. A shoe that possesses any toe spring will also place more stress on your foot nerves and increase your likelihood of developing a neuroma. Test shoes before you buy them to see if they are appropriate for your feet. Select shoes that have a removable liner or insole, and stand on the liner, noting the position of your foot. If your foot is wider than your liner, that shoe will irritate your neuroma by squeezing your metatarsal bones together.
Surgery is occasionally required when the conservative treatment is not able to relieve your symptoms, particularly if you have had pain for more than 6 months. 80% of patients who require surgery report good results, with 71% of people becoming pain-free.