Morton’s neuroma is a thickening or swelling of the nerve between the small bones of your forefeet. The nerve becomes swollen because of the nerve trapping between the heads of the small bones. We think the trapping is brought on by abnormal foot biomechanics and wearing the wrong footwear. Generally, the most common neuroma site is between the 3rd and 4th toes. One treatment option is a Morton’s Neuroma injection.

What are the common features of Morton’s neuroma?

Typically, patients describe pain at the sole, usually between the toes.  Often, pain is described as a feeling of a stone in a shoe. Pain can be like an ache, sharp, or burning. Usually, excessive walking or running can cause worsening pain. There is numbness or pins and needles radiating into the toes in some cases. Commonly, there is tenderness between the toes. In addition, a click can be felt when squeezing the toes together. This recent paper suggests that the thumb squeeze test is excellent for detecting Morton’s neuroma.

In general, it is essential to confirm a correct diagnosis with imaging. MSK ultrasound shows thickening and swelling of the nerve between the toes. In more complex cases, MRI is useful to rule out other causes of pain in the foot, such as stress fractures or toe joint inflammation.

Morton's neuroma on MRI

What are the treatment options?   

There are various ways to treat Morton’s neuroma. Some simple common treatments include changing footwear from tight-fitting to loose-fitting and ensuring footwear is not too small. Using a simple off-the-shelf orthotic can support the medial arch and reduce the load on the neuroma. Additionally, strengthening the foot muscles and stretching tight calf muscles can also help reduce pressure on the neuroma. Finally, a referral to a podiatrist can help with more complex cases.

If simple measures fail, consider a Morton’s Neuroma injection

Morton's neuroma injection

Some patients have persistent pain despite these simple measures.  Nonetheless, in these cases, a Morton’s Neuroma injection of cortisone effectively reduces pain. An injection is generally better than an ultrasound due to greater accuracy. In addition, by directing a small needle to the site of nerve swelling, we can target the exact location of nerve swelling. Generally, we recommend 1-2 injections about two months apart.

Morton’s neuroma steroid side effects

Although well-tolerated, cortisone injections have side effects. These side effects include skin atrophy, depigmentation, and damage to structures around the neuroma, such as ligaments. Generally, we reduce these risks by using ultrasound and a type of cortisone that is less potent. Also, you should only get an injection from a qualified doctor with experience in injecting Morton’s neuroma under ultrasound.

Alcohol injection for Morton’s neuroma

Other injections such as alcohol or phenol have been used with mixed success. Again, the aim is to destroy the nerve rather than reduce swelling. However, there have been a few reports of soft tissue destruction with these toxic injections. Importantly, you should have these alcohol injections done under ultrasound to avoid damaging other structures.

In addition, a technique called cryoablation is also used with some success.

Finally, surgery is an option if all simple measures fail, including one or two cortisone injections. However, it is essential to understand that surgery may leave patients with toe numbness, which may be permanent. Also, not all cases of surgery are successful.

Commonly asked questions about Morton’s neuroma: 

What happens if Morton’s neuroma is left untreated? 

This condition is benign and does not necessarily get worse. In many cases, simple treatments like a change in footwear or orthotics can improve symptoms.

Do compressive socks help Morton’s neuroma? 

We don’t think so. Generally, we suggest getting a wider, more stable shoe. Overall, compression will often make it worse.

Can Morton’s neuroma come back after surgery? 

No. But sometimes, surgery does not fix the pain even though Morton’s neuroma is completely excised. So you need to be aware that surgery is not 100%.

Can you walk after Morton’s neuroma injection? 

We suggest avoiding non-essential walking for at least a few days after injection. Indeed, you should avoid running for about a week after injection.

Final word from Sportdoctorlondon

Morton’s Neuroma is a common cause of pain in the foot and toes.  Generally, ultrasound can pick up a neuroma. Furthermore, you should try simple treatments first before undertaking a cortisone injection.

Other foot and ankle conditions:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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