A Morton’s neuroma is swelling and irritation of a nerve that lies between two metatarsal bones of your foot. It causes pain in the ball of your foot and possibly your toes. The cause is not fully understood, but local compression with tight or high heeled shoes plays a role and certainly makes the symptoms worse. It can sometimes be treated with simple measures such as calf stretchers, comfortable shoes, weight loss, insoles and simple pain tablets. If these measures do not work, an ultrasound scan may be requested and an injection of local anaesthetic and corticosteroid can be tried. Sometimes, if the response is not complete, you may require more than one injection. If this is not sufficient to control your symptoms, the trapped nerve can be surgically removed. Occasionally people have Morton’s neuromas in both feet.

What are the symptoms?

The condition commonly affects the third and fourth toes and sometimes the second and third toes but may occur between any of the toes. 

• Pain is usually experienced in a specific area of the forefoot and radiates into the toes
• Occasionally a clicking sensation is associated with the pain
• Numbness and tingling sensation
• As the condition progresses, shooting pains (like electric shocks) may be felt, even without any weight bearing

These symptoms would usually present when the foot is enclosed in a shoe and while standing or walking.

What causes this condition?

• Irritation to the nerve can be caused by various factors, including:
• Poor or altered foot mechanics
• Tight calf and leg muscles
• Inappropriate footwear - such as tight or high heeled shoes

What are the non-surgical treatment options?

Appropriate footwear

Wearing appropriate footwear - avoid tight fitting and high heeled shoes. Wear a shoe with a wider toe box and a thicker sole.

Orthoses (insoles)

Orthoses (insoles) may help to reduce symptoms by reducing stresses on the nerve.

Modifying activity

Reducing those activities that increase symptoms of pain

Stretching the calf muscle

Stretching the calf muscles may reduce pressure through the affected area

Injection therapy

A steroid injection can sometimes reduce pain by reducing the inflammation.

What are the surgical treatment options?

In those cases, which fail to respond to the non surgical treatments, surgery may be required. This involves the removal of the effected nerve.

Intermetatarsal Bursitis

An Intermetatarsal Bursitis can produce similar symptoms to those found with Morton’s Neuroma. The causes are also very similar, as are the diagnostic and treatment options. A bursa is a fluid filled sac that can forms between the long bones in the mid-foot (metatarsals), ball of the foot (metatarsal phalangeal joints) or toe web spaces. Often they occur in response to rubbing and friction within the tissues. The bursitis can become inflamed and distended with fluid which then presses on surrounding structures producing forefoot pain, tingling into the toes in a very similar way to Morton’s neuroma.

The treatment options for Intermetatarsal Bursitis are the same as for Morton’s neuroma:

• Insoles with a metatarsal raise
• Wider, deeper shoes
• Functional orthoses (a device that is contoured to the entire foot and used to reduce abnormal movement or foot position).
• Diagnostic imaging includes an ultrasound scan and an injection. This may settle the problem and can be diagnostic

Surgery is not normally needed for a bursitis, as addressing the mechanics of the foot should help to settle down this condition.