Morton’s neuroma

Morton’s neuroma is the name given to the formation of a swelling which can develop on a plantar nerve. These nerves run through the foot to supply sensation to the toes. It is thought that the development of the neuroma may be caused by long-standing compression of the nerve. This may be exacerbated by wearing tightly fitting footwear.

You may initially experience a tingling sensation in the space between your toes (most commonly between the 3rd and 4th toes), which gets worse over time. This eventually develops into a sharp shooting or burning pain at the base of your toes. There may also be some numbness in your toes. Localised pain is felt on the underside of the forefoot under the affected plantar nerve.

Prolonged walking is the normal aggravating activity, with the pain often made worse by tightly fitting footwear, which may increase the compression on the neuroma further.

Morton’s neuroma can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition and by conducting a physical examination.

The main feature on examination is often pain when squeezing the forefoot, thereby compressing the neuroma. There may be a click felt when squeezing the forefoot (a “Mulders click”) which helps confirm diagnosis.

If there is diagnostic doubt, an ultrasound or MRI scan may be performed to clarify the diagnosis.

Non-surgical management
In the majority of cases, the symptoms of Morton’s neuroma can be managed effectively by non-invasive measures as described below.

Footwear. The most effective measure is wearing the most appropriate footwear and orthotics (insoles).

Corticosteroid injection therapy. For individuals with Morton’s neuroma who continue to suffer significant symptoms in spite of using appropriate footwear and orthotics (outlined above), a corticosteroid injection can be offered as the next line of treatment. You can read more about local corticosteroid injections here.

Surgical management
Surgical removal of the painful and compressed neuroma is an effective option for patients who:

• Have trialled a course of non-surgical management without success
• Have consistent, disabling pain which limits walking distances

NHS Choices