Morton's Neuroma

Pain from a Morton’s neuroma usually occurs at the bottom of the foot between the toes. Most often this occurs between the 3rd and 4th toes (80-90%) and less often between the 2nd and 3rd toes (10-20%.) The nerve that is affected in this condition lies in the bottom of the foot just underneath the skin. This nerve can become irritated and inflamed. It can occur from excessive weight bearing on that part of the foot, but most of the time there is no clear cause. Symptoms associated with a neuroma include pain, swelling and tingling in the toes. These can often be made worse by extensive walking or exercise. Tight fitting shoes also tend to exacerbate the symptoms.

Initially treatment involves activity modification, anti-inflammatory medicines (NSAIDs and shoe wear modification (wider shoes). Another treatment option may include orthotics or metatarsal pads to help alleviate the pressure from the affected area while walking. Cortisone injections are also commonly used. In the office we inject the area around the nerve to help decrease any inflammation around it. The duration and amount of relief from an injection can vary. If an injection does not provide any significant relief, even for a short time, then the possibility of another diagnosis should be explored. It is important to note that repeated injections should be avoided. The cortisone can thin the skin and soft tissues if given multiple times, which would deplete the padding under your foot.

If all of the above treatment modalities fail to provide any significant relief, then surgery may be indicated. Surgery for a Morton’s neuroma involves excision or removal of the affected nerve. Recovery from this surgery involves mostly wound healing, which usually takes two to four weeks. For the first two weeks after surgery, a special sandal is worn to help protect the wound. At two weeks post operatively, the sutures are removed and sneakers can be worn. Because the nerve is being removed, expect some numbness in the toes in that part of the foot. This is an expected occurrence, with most patients more than happy to trade in the pain from a neuroma for numbness in the toes.