If you’ve ever experienced pain in the ball of the foot, then someone may have suggested Morton’s neuroma is the problem. While there are several causes of forefoot pain, Morton’s neuroma remains one of the most common causes. People with neuroma often get frustrated because they take a long time to become pain-free and sometimes require surgery.
About Morton’s Neuroma
In simplest terms, Morton’s neuroma is an inflamed nerve that occurs on the ball of the foot (bottom), just behind the 3rd and 4th toes. The nerve seems to get irritated by the surrounding bones (metatarsal bones) and has also been termed an intermetatarsal neuroma.
What starts as inflammation can result in scar tissue forming around the nerve and in some cases enlargement of the nerve. This nerve is particularly sensitive to excessive pressure on the foot, and neuroma can occur in women who wear high heels and tight-fitting shoes.
Morton’s neuroma symptoms involve pain, swelling, numbness, tingling, and/or burning. A common patient complaint is a sensation of walking on a rolled-up sock.
Conservative, non-invasive therapies remain the first-line approach to treating Morton's neuroma. Treatments vary according to the severity of the condition and may include:
RICE: RICE is the acronym of rest, ice application, bandage compression, and elevation of the foot.
Foot padding: Cushioning to the ball of the foot may lessen symptoms, and off-weighting pads may be effective.
Orthotics: Arch supports may better align the foot and take the pressure off the nerves.
Anti-Inflammatory medications: Medications that decrease inflammation, such as Advil (ibuprofen) and Aleve (naproxen sodium), may help reduce pain.
Intrarticular injections: There are two types of injections for Morton’s neuroma. Cortisone is a powerful anti-inflammatory medication administered every six to eight weeks that quickly reduces inflammation. Alcohol injections, also called sclerosing injections, are used to deaden or deactivate the nerve.1
When all else fails, Morton's neuroma can be treated with surgery. Surgery may be considered if conservative therapies fail to provide relief and there is evidence of subluxation (the partial dislocation) of the metatarsal joints on X-ray, ultrasound, or computed tomography (CT).2
Morton's neurectomy is the most common approach, which most commonly involves removing the nerve segment. The procedure is generally straightforward. Surgeons generally approach the area from the top of the foot, identify the nerve and follow it towards the toes and as it courses through the metatarsal bones. It is important that the surgeon cut the nerve far enough back to avoid the nerve from becoming entrapped or scarred on the ball of the foot.
The results of Morton's neurectomy are generally good. According to a study conducted at Nottingham University Hospital in England, 82% of people who underwent the operation reported good to excellent results. Roughly one out of 12 (8%) experienced no improvement at all.3
Some surgeons approach neuromas from the bottom of the foot for direct visualization, but this leaves a scar on the bottom of the foot—which can become painful to walk on.
Another approach that some surgeons utilize is to release a ligament adjacent to the nerve to decompress the area. Here the nerve is left intact. The procedure is performed with small specialized instruments.
The main benefit of surgical decompression is that is less invasive than Morton's neurectomy. A small study conducted in Japan in 2015 found it to be highly effective in reducing pain with a minimal risk of complications. Surgical decompression may be appropriate for people with persistent pain but no signs of metatarsal subluxation.4
A Word From Verywell
Like any medical issue, some treatments work for some patients and fail in others. The most important aspect of treating Morton’s neuroma properly is to be sure that the diagnosis is correct. Bunions and hammertoes are known to transfer weight onto the ball of the foot and inflame nerves, causing a resultant Morton's neuroma.
The best cure for Morton's neuroma is to be sure that you have a proper diagnosis, and that other conditions are not causing the neuroma. Morton’s neuroma generally responds well to conservative treatments, and for resistant cases, surgery can be effective.