Morton’s Neuroma

Morton’s Neuroma (also known as an interdigital neuroma, intermetatarsal neuroma or forefoot neuroma) is a painful condition that affects the ball of the foot – most often between the third and fourth toes.  It occurs when the nerve bundle between the bones at the base of the toes thickens and swells.  That swelling compresses and irritates the nerves.  This leads to inflammation, pain, numbness or tingling at the base of the affected toes.  

Morton’s Neuroma most often develops between the third and fourth toes.  The condition is caused by repetitive trauma and pressure to the area. It is more common in women than men, due to high heels and shoes with narrow toe-boxes.  

Although Morton’s Neuroma usually does not go away on its own, about 80% of cases can be easily and effectively treated and managed.  One of the most effective treatments involves changing footwear to alleviate pressure on toes and front of the foot.  

The earlier Morton’s Neuroma is treated, the better the outcome.  If ignored and left untreated, Morton’s neuroma can get worse and potentially lead to permanent nerve damage.  Proactive treatment by a foot specialist can alleviate your foot pain and help you avoid complications.

Common signs and symptoms of Morton’s Neuroma include:

• Pain in the ball of the foot – especially between the 3rd and 4th toes. This pain can radiate towards the toes or arch
• Burning, tingling, and/or numbness in the toes
• Feeling like you’re walking on a marble
• Pain that worsens with exercise and improves with rest
• Pain that worsens with tighter footwear and high heels

Morton’s neuroma is usually caused by persistent irritation, trauma or repeated compression of the nerves at the ball of the feet (or base of the toes). 

Common causes of Morton’s Neuroma include

• High-heeled shoes and shoes with a narrow toe-box:  These put persistent pressure on the joints and nerves at the toes, and also force the toes into awkward positions. Footwear is believed to be the most common cause of Morton’s Neuroma.
• Foot deformities:  Some foot conditions, such as high arches, flat feet, bunions and hammertoes, increase pressure on the balls of the foot.
• Obesity:  This increases the load placed on the toes and balls of the foot when we move, which can lead to muscle strain and irritate the nerves in the area.
• High impact activities that place repeated pressure on the forefoot.  Examples include dance and running.
• Injury or trauma to the area.

Although incredibly painful, most cases of Morton’s neuroma can be managed and treated conservatively.  The objective of these treatments is to reduce the pressure placed on the balls of the foot, or base of the toes.  This includes:

• Wearing shoes with wider toe boxes and lower heels:  This should be first line treatment of Morton’s neuroma
• Metatarsal pad or neuroma pad:  These types of padding are placed under the ball of the foot and act to open the space around the neuroma, which reduces compression and irritation of nerve tissue. These are available at our foot clinic and online shop (coming soon).  
• Custom foot orthotics: These custom-made devices can help further offload stress on the forefoot and control any contributing biomechanical abnormalities.  A foot specialist or chiropodist at our clinic can fit you for orthotics to treat your Morton’s neuroma.  

Neuroma pads and footwear options to treat your Morton’s neuroma are available at our foot clinic and online shop (coming soon).  Our knowledgeable staff can help you find supportive footwear solutions that offset pressure on the balls of your feet, support healthy biomechanics, and look great too!  

The following at-home treatment options can also help manage Morton’s neuroma:

• Strengthening and stretching exercises:  By strengthening the muscles and ligaments in our feet and lower legs, we can alleviate the strain our everyday activities place on our toes and the balls of our feet. Click here to see some great stretches and exercises to relieve your foot pain.  
• Icing the affected area:  Icing temporarily reduces swelling.  However, it won’t address the underlying source that’s causing the swelling in the first place.
• Rest or reduction of activities that place excessive strain on the toes and balls of the feet. 

In more severe cases that do not respond to the above treatments, the following may be considered:

• Injection therapy:  A corticosteroid injection can help to provide temporary relief.
• Surgery:  This is done if other treatments do not work.

To find out how to treat your Morton’s neuroma, schedule a foot assessment with one of our skilled chiropodists – no referral required.  Use our online booking form or call us at 416-769-3338 to book your assessment today. 

The following can make you more prone to developing a Morton’s neuroma:

• Tight fitting footwear or shoes with a narrow toe box (i.e.: pointed toe shoes, dress shoes)
• Overpronation
• High arches, which increase pressure on the ball of the foot.
• Gender:  Morton’s neuroma is more common in females and in active individuals, usually aged 15-50 (the higher prevalence of Morton’s neuroma in women is believed to be footwear-related)
• Clawed toes, hammertoes and bunions: These conditions can stretch the intermetatarsal structures (the space between the bones at the base of the toes) and apply excessive strain to the ball of the foot.
• Impact sport or physical activities that create excessive pressure on the forefoot. Examples include elliptical, cycling, dance, incline walking or running.

Since Morton’s neuroma is caused by repetitive trauma to the nerve, either from poor biomechanics, foot type or choice of footwear, prevention is aimed at controlling these factors.  This can be accomplished through the following: 

• Biomechanical abnormalities are addressed with proper orthotics and exercise. Annual assessments by a foot specialist should be scheduled to reduce risk of Morton’s neuroma. 
• Shoes should properly fit the toe box so that toes have sufficient space and are not crowded or bent. 
• Laces or Velcro enclosures can keep the foot towards the back of the shoe so that weight isn’t carried forward toward the front of the foot and shoe.
• Avoid or reduce the frequency that you wear high heels.  You can try limiting high heels to special occasions.  You can also check out some of the foot-friendlier heels available at our foot clinic and online foot shop (coming soon).
• Wear footwear with good arch support that encourages proper weight distribution and biomechanical movement in the feet.  This will alleviate any repetitive strain or pressure placed on the balls of the feet and base of the toes, which reduces the possibility of developing Morton’s neuroma.