Morton's Neuroma

Interdigital neuroma more commonly known as Mortons neuroma is an entrapment of a nerve that passes into the toes of the foot. The nerve gets entrapped or “pinched” by the metatarsal bones, which are the bones just behind the toes. Typically this type of foot pain is the result of wearing shoes that are too narrow or in the case of women, high heel shoes. Other factors that will cause this condition can be the specific architecture of a person’s foot structure as well as occupational hazards such as those who work low to the ground forcing them to kneel down for long periods. An example would be someone who spends long hours planting flowers in a garden; the ball of the foot is being constantly overstretched.

This condition can be very painful. Typically, a person will be walking in shoes (although the condition can be painful out of shoes as well), and will develop a sharp pain just behind the third and fourth toes.

This pain may then radiate into the toes and manifest itself as overt pain, numbness, tingling or burning. This is the most common location for Mortons neuroma, but this condition can also affect the other toes as well. On occasion this pain may also travel backwards further into the foot. Many people will relate that they can feel a “clicking” in the affected area. This is actually the nerve moving up and down between the pressures of the adjacent metatarsal bones. People find that if they remove their shoes and rub the area for a couple of minutes, the pain will subside, only to return once they start walking again.

There are a number of treatments for this condition depending on the severity. Sometimes, just identifying the certain pair of shoes that sets off the pain and no longer wearing them will eradicate the problem.

Anti-inflammatory medication can be helpful, but this should be considered temporary relief and should not be considered for long-term treatment, as there are potential systemic problems with taking this type of medication for long periods of time.

A foot specialist (podiatrist) may recommend an orthotic device, which is a sophisticated arch support, custom made to the foot structure of the patient’s foot. The purpose of which is to control the abnormal structural components of the foot, which is contributing to the condition. Many times a neuroma spacer pad can be build into the orthotic which then attempts to spread apart the adjacent metatarsal bones and thereby remove the pressure on the nerve, thus reducing pain. I generally reserve this type of treatment for patients who are not candidates for other types of treatment as I consider it a “stop gap” measure.

Injection of the area can also be very helpful. Some doctors will inject cortisone in an effort to reduce inflammation of the nerve. Others may recommend injecting denatured alcohol, which attempts to sclerose, or deaden the nerve. Both can be very effective. My preferred treatment is multiple injections of denatured alcohol. Any where from one to seven injections repeated on a weekly basis are necessary. I have found the success rate to be in the 80-85 percent range.

When all else fails, surgical excision is usually recommended. This is an out patient procedure where the entrapped nerve is removed. As with any surgery there are potential complications and your doctor should explain these to you. The two biggest complications are misdiagnosis of the neuroma, the nerve is removed and the patient still has pain. The second, more common complication is not resecting enough of the nerve and being left with what we call a stump neuroma. These can be particularly painful and frustrating for the patient.