Morton’s Neuroma is a pathological condition of the common digital nerve between the third and fourth metatarsals (third inter-metatarsal space). The nerve sheath becomes abnormally thickened with fibrous (“scar”) tissue and the nerve fibers eventually deteriorate. This common digital nerve runs along the bottom (plantar) surface of the foot and branches to supply sensation to the plantar aspect and tips of the third and fourth toes. Occasionally, the common digital nerves in the second inter-metatarsal space is affected. Very rarely the nerve in the first or fourth inter-metatarsal space is involved.

 
Morton-neuroma-diagram


 

Symptoms

  • Pain in the ball of the foot and/or one or two small toes (usually the third and fourth)
  • Intermittent in nature – it may disappear as quickly as it came
  • Pain is often sharp, burning, or cramping in nature
  • Pain may radiate into toes or up the foot/ leg
  • Aggravated by tight shoes and prolonged weight bearing
  • Removing the shoe often relieves the pain

Causes

  • The exact cause is unknown
  • It may involve mechanical irritation of the nerve
  • Abnormal foot structure or mechanics (e.g.. flatfoot and the high arched foot) contributes to irritation of the nerve
  • Tight fitting footwear may contribute and aggravate the problem

What you can do

  • Remove the shoe and massage your forefoot
  • Rest the foot
  • Wear shoes with a broad forefoot, low heel, and a good arch (e.g.. running or walking shoe)

What the doctor may do

  • Manipulate the foot attempting to feel (palpate) the enlarged nerve
  • Order special diagnostic imaging to establish a diagnosis, if questionable
  • Apply orthopedic pads to relieve pressure on the nerve
  • Use physical therapy
  • Inject powerful anti-inflammatory medication around the affected nerve
  • Prescribe proper functional foot orthotics to control abnormal motion
  • Recommend surgical excision of the diseased nerve

Other causes of forefoot pain

  • Metatarsalgia (pain and inflammation of the metatarsal bones and their soft tissue sheath)
  • Capsulitis (pain and inflammation of the joints between the metatarsal bones and toes)
  • Tendonitis (inflammation of the tendons which course along the top of the foot)
  • Partial or complete dislocation of a joint between a metatarsal and a toe (metatarsal-phalangeal joint)
  • Severe plantar callus (callus on bottom of the foot)
  • Bursitis (an inflamed fluid-filled sac often between a bone and an area of pressure)