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Morton’s Neuroma

by Raj N. Sureja, MD
Have you ever gotten a rock or sand in one of your shoes while walking? Immediately, you know that something is amiss and reach down to remove your shoe and the offending object(s). Now imagine having that feeling, but when you look in your shoe, there is nothing there. That is how it feels to have Morton’s Neuroma.
Morton’s neuroma is the thickening of the nerve tissue, usually between the third and fourth toe near the ball of the foot, but it can occur near any toe. It is caused by compression or damage of the nerve. Symptoms of a Morton’s neuroma include a burning pain in the ball of the foot as well as the toes, a lack of feeling in the toes, and the feeling that a pebble or other object is under the foot while standing.
Shoe choice can play a role in the development of Morton’s neuroma. Wearing shoes with high heels or shoes that are too narrow can cause extra pressure on the ball of the foot, resulting in damaged nerves. People with a previously existing foot condition, such as bunion or hammertoes, and people with arches that are too high or too shallow are at greater risk of developing Morton’s neuroma. Another potential cause includes activities that result in repeated pressure on the ball of the foot. Running, basketball, and tennis are examples of activities that put a person at a higher risk for Morton’s neuroma.
This condition can be diagnosed by a physician conducting a physical examination of the hurting foot. They will feel for a bump on the bottom of the foot near the toes. This painful mass is the inflamed nerve tissue that is Morton’s neuroma. An X-ray may be required to ensure that the foot pain is not caused by another condition, such as a broken bone. Ultrasounds are often used to show the presence of neuromas and may also be requested by the physician to confirm the diagnosis.
Non-surgical treatments include over-the-counter pressure pads for shoes or prescribed orthotics that fit inside a shoe to relieve the pressure on the nerve and therefore the pain. Other conservative treatment includes icing and over-the-counter anti-inflammatory medication.
If pain and symptoms persist in spite of these other treatments, you may be referred to an Orthopaedic or Pain Management Physician for further treatment. Orthopaedists will typically try cortisone injections to relieve inflammation first. Pain Management Physicians, such as myself, will prescribe drugs with help with nerve pain, such as Lyrica or Gabapentin. We will also recommend physical therapy to help the patient stretch and release tight tendons and ligaments which may be adding pressure on the neuroma.
If pain relief is not attained, interventional or surgical options may be considered. Surgical options include decompression surgery, which involves the cutting of ligaments around the nerve in order to relieve the pressure on the neuroma. Another surgical option involves the removal of the entire nerve tissue mass. However, this surgery may result in the permanent loss of feeling in the toes or an increase in pain.
The best way to prevent surgery is to see a physician or foot specialist shortly after the first sign of symptoms. Regardless of the type of treatment, and regardless of the success of the treatment, wearing shoes that fit properly and that are appropriate for the activity is essential to reduce the pressure placed on of the foot.

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