Morton’s neuroma is a condition affecting the ball of the foot, where nerve tissue between the toes becomes thickened and irritated. In over 85% of patients, this thickening occurs between the third and fourth toes (the space between the second and third toes accounts for most of the remaining cases). Patients will often report feeling the sensation of stepping on a pebble where the neuroma is present.
This type of neuroma is usually associated with wearing shoes with a tapered toe box, or high heel shoes, both of which compress the structures of the forefoot. Because of the causative role of this type of footwear, Morton’s neuroma is particularly common among women over 45, with studies showing a female-to-male ratio of about 4:1. Those who participate in high-impact activities such as running or sports are also more susceptible to Morton’s neuroma.
Many patients have non-painful neuromas in their feet. These are often observed in MRI or ultrasound. When there are symptoms, the most common are pain, a sensation of a mass in the ball of the foot, and/or burning or numbness.
While Morton’s neuroma can usually be confirmed through imaging, it’s important to rule out other conditions with similar symptoms. These include bursitis, stress fractures, metatarsophalangeal (MTP) joint synovitis, or even tarsal tunnel syndrome.
Early-stage Morton’s neuroma symptoms may be treated by conservative methods, which avoid surgery in favor of a non-invasive approach. These can range from corticosteroid injections to the use of ultrasound-guided procedures such as cryoablation.
In moderate to severe cases, surgery is required. The procedure may involve removing affected ligaments and decompressing the nerve, or complete removal of the nerve itself.