Morton’s neuroma symptoms and treatment

Morton’s neuroma is an overgrowth of nerve tissue that causes pain in the ball of the foot. If you have a Morton’s neuroma you may feel as if there is a pebble in your shoe. Eventually you may suffer a sharp, burning pain in the foot and numbness between the toes.

Repetitive foot overload, from wearing tight shoes or from high impact sports, is a common cause for Morton’s neuroma. Simple measures like switching to comfortable shoes, stopping high impact exercise, and wearing orthotic supports, may relieve the pain.

For long-lasting neuroma pain, a visit to a pain management doctor can help. Corticosteroid injections and advanced techniques like nerve ablation and cryotherapy may treat your pain, without surgery.

What is Morton’s neuroma?

Neuromas are tissue growths around the nerves, that can occur in a number of places around the body. Although benign (non-cancerous), these growths can trap the nerve, causing pressure and pain. If left untreated, they may cause permanent nerve damage.

Morton’s neuromas occur in the ball of the foot, commonly in the area between the second and third toes or between the third and fourth toes. They grow along the nerves that provide sensation to the toes.

What causes Morton’s neuromas?

Morton’s neuromas develop in response to repetitive overload on the foot.

Causes for Morton’s neuroma:

• High-heeled, narrow shoes – Morton’s neuroma is more common in women, due to use of high-heeled, narrow shoes that place the foot bones in a strained position.
• Foot deformities – people with bunions, hammertoes, flat feet or overly flexible feet are at increased risk for neuroma growth.
• Certain sports – high impact activity (running, court sports) subjects your feet to repetitive trauma. Sports that require tight shoes (snow skiing) put pressure on the foot.
• Excessive weight – being overweight increases foot strain.

What does a Morton’s neuroma feel like?

Usually, there are no lumps or any other outward signs. The problem starts gradually, with burning pain. First, there is only occasional pain, for example when you wear narrow shoes. The pain stops when you remove the triggering factor (shoe). However, as the neuroma grows, pain can become intense and last for days or weeks at a time.

Common symptoms:

• Burning pain in the ball of your foot that shoots into the toes
• Tingling or numbness at the base of the 2nd-3rd or 3rd-4th toes
• Feeling of having a “pebble in your shoe” or “walking on razor blades”
• Pain that improves with removing your shoes, flexing your toes, and with a foot massage
• Pain with standing or walking

Will a Morton’s neuroma go away?

Once it has formed, a Morton’s neuroma will not go away. However, the pain can improve, or even disappear. The earlier you receive treatment, the better your chance of having the pain resolve.

With more advanced neuromas, the pain may return in episodes as you spend a lot a time on your feet, or continue wearing tight shoes. This may require repeat treatments. A neuroma can be removed entirely, through surgery. However, there is a 20-30% chance of it re-growing (stump neuroma).

When do I see a doctor?

It is best to seek help in the first weeks after your start having foot pain or numbness. It helps to see a pain management doctor early on, in order to start conservative (non-surgical) treatments, such as pain-numbing or steroid injections. If further treatment is needed, you may benefit from radiofrequency ablation or cryoablation, before seeking a surgical solution.

How is a Morton’s neuroma diagnosed?

Diagnosis is based on a detailed patient history and on the location of your foot pain. Your doctor will want to rule out other reasons for foot pain such as arthritis, joint or ligament problems, and old injuries.

On exam, your doctor will check for swelling, numbness, weakness and limited foot motion. Morton’s neuroma pain can be reproduced by squeezing the sides of the foot. If further testing is needed, additional imaging may be done.

Imaging tests for neuroma detection:

• X-rays – do not detect soft tissue growths such as a neuroma; they rule out other causes for pain, like stress fractures or arthritis.
• Ultrasound – sound waves create live images of nerves and soft tissue growths, like neuromas. Ultrasound also detects other conditions that occur alongside neuromas, such as bursitis (inflammation around the bones).
• MRI – magnetic resonance imaging uses a strong magnetic field, to visualize soft tissues, such as neuromas.

How do you treat Morton’s neuroma?

For mild to moderate pain, Morton’s neuroma treatment starts with conservative measures. More than 80% of people with a Morton’s neuroma will improve with a conservative approach.

Conservative (first-line) treatments

• Change in shoes – low heels, wide toes and good arch support will reduce pressure on the foot.
• Padding – padding the foot arch reduces pressure on the nerve when you are walking.
• Icing – helps reduce swelling in the foot.
• Orthotic devices – custom-made orthotic arch and ankle supports reduce pressure on the neuroma.
• Activity modification – repetitive foot pressure due to sports (running, racquetball, mountain climbing) should be avoided until the neuroma pain improves.
• Anti-inflammatory medication – drugs such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) reduce inflammation-related pain.
• Injection therapy – an injection of local anesthetic (nerve-numbing Lidocaine) and steroids into the foot, helps decrease pain and inflammation.

Advanced injection techniques – treatment

If pain continues despite several months of conservative treatment, your pain doctor may recommend advanced injection techniques. They are conducted in an outpatient setting, with local anesthesia (foot numbing), and ultrasound guidance.

Sclerosing alcohol injections– diluted alcohol is injected in the neuroma in order to destroy it. Treatment is repeated 2–4 times.

• Success rate equal to or exceeding that for surgical neurectomy, with fewer risks. However, approximately 20% of cases may progress to surgery.
• Short-term pain after the procedure is common.

Radio Frequency Ablation – (RFA) heat generated from medium frequency alternating current is used to ablate (cut) the neuroma.

• Equally or more reliable than alcohol injections.
• An effective treatment after conservative treatment fails and prior to surgical intervention.

Cryogenic neuroablation – (cryosurgery or cryoablation) involves a small incision in the foot and insertion of a cooled needle (−50 °C) in order to freeze the neuroma.

• Less painful than alcohol injections.
• Can be used instead of neurectomy (surgery that cuts out the neuroma).
• Unlike neurectomy, it does not have a risk of neuroma regrowth.

Surgery

Surgery is performed to widen the space through which the affected painful nerve travels or to remove the neuroma.

Decompression surgery – involves cutting a tight ligament that puts additional pressure on the nerve/neuroma.

Neurectomy – (more commonly used surgery) cuts out the neuroma and part of the affected nerve.

• Requires a greater recovery time, where the patient must avoid standing.
• Increased risk that scar tissue will form and cause ongoing pain (stump neuroma).

How can I avoid a Morton’s neuroma?

Simple measures patients can take to decrease pain:

1. Wear supportive shoes
2. Use an arch support
3. Wear shoes with a wide toe box
4. Modify your activities
5. Lose weight