DEAR DOCTOR K:
I have something called Morton’s neuroma. Can you explain what it is, and what I can do to relieve the pain?
A neuroma develops when a nerve is compressed, injured or pinched, causing swelling and pain. A neuroma in the area between the third and fourth toes, or between the second and third toes, is known as a Morton’s neuroma. (I’ve put an illustration of Morton’s neuroma below.)
A view of Morton’s neuroma
Along the bottom of the foot, the nerves of the toes pass between the metatarsal bones. As a result of tight-fitting shoes or activities such as jogging or dancing, these nerves can be compressed by the bones and become irritated. The area between the third and fourth toes is the most common site for this condition, which is named Morton’s neuroma after the doctor who first described it.
Morton’s neuroma causes sharp, burning pain and numbness in the toes and foot. You may feel like you’ve stepped on a tiny hot coal and can’t get rid of it. At the same time, you’ll have the disconcerting experience of not being able to feel your toes. Sometimes the nerve tissue becomes so thickened you can feel or see a lump.
Women, particularly those who wear tight shoes, are at greatest risk for Morton’s neuroma. The best way to prevent the condition is to wear shoes with wide toe boxes. Tight, pointed shoes squeeze bones, ligaments, muscles and nerves. High heels may worsen the problem by shifting your weight forward. Over time, this combination can cause the nerves to swell and become painful.
Wearing shoes that provide enough room in the toe box is also the first step in treating Morton’s neuroma. For instant relief when pain flares up, try taking your shoes off and rubbing the area. The nerve can get trapped below the ligament, and rubbing can move it back to its natural position.
Your doctor or a foot-care specialist may recommend lower heels and metatarsal pads. These pads provide cushioning under your neuroma and better arch support to redistribute your weight. Custom shoe inserts will help correct structural problems and distribute the pressure more evenly.
If you’re in severe pain, your doctor may give you an injection of a local anesthetic combined with a corticosteroid to relieve the inflammation and pain. If you keep pressure off the toes and wear wide enough shoes, the problem may gradually disappear.
For severe or persistent pain, you may need surgery to remove the neuroma. Once the nerve is gone, you permanently lose feeling in the affected area.
One alternative to surgery is to undergo neurolysis injections. These use chemical agents to block pain signals. Another alternative is to take a prescription pain reliever that alleviates nerve pain.
At Harvard Medical School, we survey patients about health topics that they would be most interested in learning about. Not surprisingly, there are many votes for healthy lifestyle (like healthy eating and exercise). And also many votes for the major diseases, such as heart disease, cancer, strokes, diabetes and Alzheimer’s disease.
But you’d be surprised how many people vote for learning more about how to deal with their aching feet. A lot of us have sore feet, and Morton’s neuroma is one of the more common causes.