Morton’s Neuroma Symptoms and Treatment

If you feel the presence of a pebble in your shoes when you walk, or experience sharp burning pain and numbness between the toes, you have Morton’s neuroma. It involves a thickening of the tissue around one of the nerves, leading to the toes. Long-lasting Morton’s neuroma can be very painful and affect your routine life, making it hard for you to stand or walk easily. Visit a pain management doctor at the Century Medical and Dental Center to have your condition diagnosed and to get the best advice on relieving pain. The top foot doctor recommends the best treatment and therapies to make you better feel better and prevent the overgrowth of the nerve tissue.

What Is Morton’s Neuroma?

Also called intermetatarsal neuroma, Morton’s neuroma is an overgrowth or thickening of nerve tissue that causes pain in the ball of the foot. This condition usually results from repetitive foot overload caused by wearing tight shoes or high-impact sports gear.

Neuromas are tissue growths around the nerves that can occur in several places around the body. Although they are 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, resulting in intense pain.

What Causes Morton’s Neuromas?

Morton’s neuromas usually develop in response to frequent overload on the foot. Some common causes of Morton’s neuroma include:

• Wearing high-heeled, narrow shoes – this condition is more common in women as they wear long heeled, narrow shoes that place the foot bones in a strained position;
• Foot deformities – people suffering from bunions, hammertoes, flat feet, or overly flexible feet are at higher risk of neuroma growth;
• Specific sports – high impact sports such as running or court sports can have a traumatic effect on the feet. Also, sports that require wearing tight shoes, such as snow skiing, increase the pressure on the foot;
• Increased weight – being overweight can increase foot strain and lead to neuroma growth.

Symptoms of Morton’s Neuroma

Most people do not have any outward signs of Morton’s neuroma or lump to indicate its presence. The problem starts gradually, and you may feel a burning pain. There is only occasional pain when you wear narrow shoes, and it stops when you remove the triggering factor such as pointed shoes or get injured. The pain can intensify as the neuroma grows, and it can last for days and even weeks if it is not managed timely.

What Does Morton’s Neuroma Feel Like?

Common symptoms of Morton’s neuroma include:

• A sensation of burning pain in the ball of the foot that shoots into the toes;
• Tingling or numbness at the base of second-third toes or third-forth toes;
• A feeling of having a stone in your shoe or walking on razor blades;
• Pain that improves when you take off your shoes, flex the toes, or get a foot massage;
• Pain, when you walk or stand.

How to Treat Morton’s Neuroma?

Morton’s neuroma does not go away on its own once it has formed. In specific cases, the pain can improve or even disappear. The earlier you receive the treatment, the better your chances of recovery.

Advanced cases of neuromas require medical treatment as the pain may return in episodes, and you will face considerable discomfort. If you spend a lot of time on your feet or wear tight shoes, you may require repeat treatment.

A neuroma can be completely removed through surgery, but there is a 20-30% chance of regrowth, also known as a stump neuroma. The pain management doctor can guide you in this regard and help you make the necessary lifestyle changes to avoid neuroma development and prevent its regrowth.

When to Seek Medical Assistance for Neuroma?

If your foot pain does not go away even after changing your footwear and stopping activities that might be responsible, schedule an appointment with your doctor. It is best to seek medical care in the first weeks after you start having foot pain or numbness. The foot doctor can start conservative or non-surgical treatment such as pain-numbing or steroid injections and pain-relieving medications.

If these injections and medications are not helpful, the doctor may recommend radiofrequency ablation or cryoablation. Surgery is the last option to remove the neuroma.

Diagnosing Morton’s Neuroma

Morton’s neuroma is detected with physical examination, using the patient’s medical history, and the location of the pain. The doctor will also rule out other reasons for foot pain, such as arthritis, joint or ligament problems, and old injures to make an accurate diagnosis.

The doctor will also look for swelling, numbness, weakens, and limited foot motion to ensure no underlying condition is causing these symptoms. Morton’s neuroma pain can be reproduced by squeezing the sides of the foot. In case further testing is needed, the doctor will recommend imaging.

Imaging tests for detecting neuroma include:

• X-rays – they cannot detect soft tissue growths but help to rule out other causes for pain like stress fractures or arthritis;
• Ultrasound – sound waves create live images of nerves and soft tissue growths and detect other conditions such as inflammation of the bones;
• MRI – magnetic resonance imaging uses a strong magnetic field, to visualize soft tissues, such as neuromas.

Treatment Options for Morton’s Neuroma

Mild to moderate pain can be relieved with pain-relieving medications, lifestyle changes, and non-surgical therapies. More than 80% of the people suffering from Morton’s neuroma feel better with a conservative approach.

First-line conservative treatment includes:

• A change of footwear – low healed, wide toe shoes with good arch support can reduce pressure on the foot and ease the pain;
• Padding – padding the foot arch can relieve the pressure on the nerve when you walk;
• Icing – icing can keep down the swelling on the foot;
• Orthotic devices – you can use custom made orthotic arch and ankle support to keep away the pressure from the neuroma;
• Adjustment in activities – avoiding or reducing repetitive foot activities such as running, climbing, and mountain climbing to improve the neuroma pain;
• Anti-inflammatory medications – over the counter medications such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) lessen inflammation-related ache;
• Injection – local anesthetic that numbs the nerves and steroids are injected into the foot to deal with pain and inflammation.

Other conservative treatments include:

• Physical therapy;
• Stretching exercises to loosen tendons and ligaments;
• Massaging the ball of your foot;
• Exercises to strengthen your ankles and toes;
• Resting your foot;
• Applying ice to sore areas.

They help manage the symptom so that you can get back on your feet without going through too much pain.

Advanced Treatment for Morton’s Neuroma

If your pain fails to subside after several months of conservative treatment, the foot specialist may recommend advanced treatment that includes injection techniques. They take place in an outpatient setting with local anesthesia for numbing the foot, guided by ultrasound.

The injections are:

1. Sclerosing alcohol injections – Diluted alcohol is injected into the neuroma to destroy it. Treatment is repeated 2–4 times. It is more successful than surgery and has fewer risks. The patient may experience short-term pain after the procedure. However, about 20% of the cases may need surgery if the neuroma fails to go away.
2. Radio Frequency Ablation (RFA) – Heat generated from medium frequency alternating current is used to ablate or cut the neuroma. It is equally or more reliable than alcohol injections and considered highly effective when conservative treatments fail or before heading for surgery.
3. Cryogenic neuroablation or cryoablation – It involves a small incision in the foot and the insertion of a cooled needle (−50 °C) to freeze the neuroma. It is less painful than alcohol injections, and it can be used instead of surgery that cuts down the neuroma. The good thing about this injection is that it does not have any risk of neuroma regrowth.

Surgery

Doctors use surgery as the last option if no other treatment works. Surgery widens the space through which the affected painful nerve travels or removes the neuroma.

• Decompression surgery – It involves cutting the tight ligament that is putting additional pressure on the nerve or neuroma.
• Neurectomy – It cuts out the neuroma and a part of the affected nerve to get rid of the pressure and the pain it is causing. It is the more commonly performed surgery.

The patient must avoid standing during the recovery period, as increased pressure or scarred tissue can result in stump neuroma and even more pain.

How to Prevent Morton’s Neuroma?

Doctors recommend simple measures to prevent Morton’s neuroma and decrease its pain. They include:

• Wearing supportive shoes;
• Using arch support;
• Wearing shoes with a wide toe box;
• Modifying your activities;
• Losing excessive weight;
• Use anti-fatigue mats to provide relief to your feet.

Morton’s neuroma is a benign condition, but it can be painful and even lead to permanent nerve damage and walking disabilities if you do not seek medical attention.

The experienced and board-certified foot doctors at the Century Medical and Dental Center work hard to keep you and your family as active as ever, despite these painful conditions. They use the best diagnostic tools to learn more about your pain and develop effective solutions to manage it while your body heals. For most people, changes in footwear, life adjustments, and exercises are enough to ease or stop the symptoms. If they fail to work for you, the pain management doctors come up with advanced treatment methods, including surgery to prevent benign nerve growth and help you get back on your feet and routine life.

SHARE THIS POST Page Updated on Dec 18, 2022 by Dr. Dvorkina (Primary Care Doctor) of Century Medical & Dental Center