Morton’s Neuroma is a painful foot condition that prompts many to ask if it will resolve without medical intervention. The discomfort is frequently described as a sharp, burning pain in the ball of the foot, often feeling like standing on a marble or a bunched-up sock. This nerve irritation can severely limit daily activities and walking comfort.
Defining the Condition
Morton’s Neuroma involves a thickening of the tissue surrounding one of the digital nerves in the foot, most commonly between the third and fourth toes. This condition is technically a compressive neuropathy, not a true tumor, despite the historical name. The nerve tissue becomes inflamed and enlarged due to chronic irritation or compression. Primary symptoms include sharp or burning pain in the forefoot, numbness, tingling, and a feeling of a lump. The irritation is frequently exacerbated by standing, walking, or wearing restrictive footwear like high heels or shoes with a narrow toe box. Contributing factors may include foot deformities such as bunions or flat feet, as well as repetitive stress from high-impact sports.
Natural Progression and Spontaneous Healing
Once Morton’s Neuroma is established, it generally does not resolve on its own. This persistence is due to the physical pathology of the neuroma. Chronic compression causes the nerve tissue to undergo structural changes, specifically a non-cancerous thickening and enlargement (fibrosis). This physical alteration requires external intervention to reduce the inflammation and thickening.
An early, temporary irritation, known as neuritis, might resolve with rest and removing the irritating factor. However, once the nerve has progressed to a true neuroma with sustained tissue thickening, the change is permanent without treatment. Ignoring the condition allows the thickening and surrounding fibrosis to worsen, leading to increasing pain and a more challenging treatment process.
Non-Invasive Treatment Approaches
Since the neuroma does not spontaneously resolve, the initial strategy focuses on conservative, non-invasive treatments aimed at reducing nerve compression and inflammation. Footwear modification is the first line of defense, requiring a switch to shoes with a wide toe box and a low heel. This allows the toes to spread naturally and reduces pressure on the forefoot, preventing symptoms from worsening.
Metatarsal pads or custom orthotic inserts are also effective strategies to redistribute pressure away from the affected intermetatarsal space. These devices subtly lift and separate the metatarsal bones, helping to decompress the irritated nerve. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can manage pain and reduce local inflammation. Applying ice or cold packs to the ball of the foot also helps reduce swelling and provides short-term relief.
Medical and Surgical Options
When conservative measures fail to provide adequate relief after several months, more advanced medical interventions become necessary. A corticosteroid injection delivers a powerful anti-inflammatory medication directly into the tissue surrounding the neuroma. This treatment reduces inflammation and swelling of the nerve, often guided by ultrasound for precise placement.
If symptoms persist, an alcohol sclerosing injection may be considered. This works to chemically destroy the nerve fibers and reduce the nerve’s ability to transmit pain signals. A sequential approach of steroid injections followed by alcohol injections for non-responders is a cost-effective treatment pathway. Surgical intervention is typically reserved as a last resort. This involves a procedure called a neurectomy, where the affected section of the nerve is removed through an incision on the top of the foot. Another surgical approach is nerve decompression, where surrounding tissue is released to relieve pressure on the nerve.