A neuroma in the foot, most commonly known as Morton’s neuroma, is a painful condition resulting from the thickening of nerve tissue, typically located between the third and fourth toes in the ball of the foot. This thickening is not a true tumor but rather a degenerative change in the nerve, often caused by chronic compression and irritation. It often feels as though you are walking on a marble or a bunched-up sock inside your shoe. Treating this condition follows a structured escalation of care, beginning with simple adjustments and moving toward advanced medical procedures if necessary.
Recognizing the Signs and Diagnosis
The symptoms of a neuroma are distinct, involving a sharp, burning pain in the ball of the foot that can radiate into the toes, often accompanied by numbness or tingling (paresthesia). The pain usually worsens with activity or when wearing tight shoes, which increases pressure on the irritated nerve.
Physicians begin diagnosis with a physical exam, which may include the Mulder’s Click test. This test involves squeezing the sides of the forefoot to compress the metatarsal bones, which can reproduce the patient’s pain or cause a palpable “click” as the neuroma moves. Imaging studies are used to confirm the diagnosis and exclude other causes of forefoot pain, such as stress fractures or arthritis. Ultrasound and Magnetic Resonance Imaging (MRI) are effective tools for visualizing the thickened nerve tissue and determining its exact size and location.
Conservative and Lifestyle Modifications
The initial line of defense against a neuroma involves conservative management and simple lifestyle changes designed to reduce nerve irritation and pressure. Modifying footwear is the first step. Wearing shoes with a wide toe box allows the toes to spread naturally, reducing compression on the nerve. High-heeled shoes and those with narrow, pointed toes should be avoided, as they force the forefoot into a position that aggravates the condition.
Specialized padding and support can significantly offload pressure from the painful area. Metatarsal pads, whether over-the-counter or custom-placed, are positioned behind the ball of the foot to spread the metatarsal bones and create more space for the nerve. Custom-made foot orthotics provide more specific support and improve overall foot mechanics, which may reduce the repetitive trauma contributing to neuroma formation.
Reducing high-impact activities that subject the forefoot to repetitive stress is also beneficial. Sports like running or jogging that require repeated pressure on the ball of the foot may need to be temporarily curtailed or replaced with lower-impact alternatives. Initial pain relief measures include applying ice to the affected area to decrease inflammation and using over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Patients should consult a healthcare provider before beginning a regimen of pain medication.
Targeted Medical Procedures
When conservative treatments fail to provide adequate relief, targeted medical procedures administered by a physician become the next step in care. Corticosteroid injections deliver a potent anti-inflammatory medication directly into the tissue surrounding the neuroma. This procedure aims to reduce swelling and inflammation, often providing temporary pain relief that can last a few weeks to several months. However, the effects are often short-lived, and multiple injections may carry risks like fat pad atrophy or weakening of surrounding tissues.
An alternative approach is alcohol sclerosing injections, a form of chemical neurolysis. This technique involves injecting a concentrated alcohol solution into the area around the neuroma to chemically destroy the nerve tissue. A series of injections, typically requiring three to seven treatments spaced every few weeks, is usually necessary to achieve long-term pain resolution.
Cryotherapy and radiofrequency ablation (RFA) are minimally invasive options that use energy to deactivate the nerve. Cryotherapy uses a specialized probe to freeze the nerve tissue, disrupting its ability to transmit pain signals while preserving structural integrity. RFA achieves a similar effect by using heat energy to damage the problematic nerve. Both cryotherapy and RFA are often performed under ultrasound guidance to ensure precise targeting.
Considering Surgery and Post-Procedure Outlook
Surgery is reserved for cases where non-surgical methods have failed and the patient continues to experience debilitating pain. The two primary surgical approaches are neurectomy and decompression. A neurectomy involves the surgical removal of the affected nerve and the thickened tissue. This is often performed through an incision on the top of the foot to avoid scarring on the weight-bearing surface.
Decompression surgery focuses on relieving pressure on the nerve without removing it. This procedure involves releasing the deep transverse metatarsal ligament, a band of tissue that compresses the nerve. Surgeons may favor decompression, particularly for smaller neuromas, because it avoids the potential complication of forming a painful stump neuroma, which can occur after nerve removal.
Recovery from neurectomy can be lengthy, with patients typically needing to wear a protective shoe for several weeks. A full return to activity may take up to three months or more. Permanent numbness in the toes supplied by the removed nerve is a typical outcome. While surgery is generally successful, a small percentage of patients may experience persistent pain or recurrence, making realistic expectation management important.