Morton’s neuroma is a common foot ailment often causing sharp, burning pain in the ball of the foot and toes. This condition is not a true tumor but rather an enlargement and thickening of the tissue surrounding a nerve, most frequently located between the third and fourth toes. The chronic irritation and compression of this nerve lead to discomfort that can feel like walking on a marble or a bunched-up sock. Understanding the underlying physical changes and the various treatment paths is the first step in addressing the question of whether this painful condition can ever truly resolve.
Understanding Why Morton’s Neuroma Persists
Repetitive micro-trauma, often caused by tight shoes or abnormal foot mechanics, repeatedly squeezes the nerve against the transverse intermetatarsal ligament. This chronic irritation triggers a biological response in the nerve tissue.
This prolonged pressure causes damage and subsequent thickening, known scientifically as perineural fibrosis. Fibrosis involves the growth of fibrous scar tissue around and within the nerve, resulting in an enlarged and damaged structure. Once this structural thickening is established, the nerve itself remains physically entrapped and compressed. The presence of this fibrotic tissue explains why simply resting the foot may relieve symptoms temporarily but does not make the neuroma physically “go away.”
Non-Surgical Paths to Symptom Resolution
Footwear modifications are often the first step, including avoiding high heels and choosing shoes with a wide toe box that allows the toes to spread naturally, directly addressing the mechanical compression that aggravates the neuroma. Custom orthotics or simple metatarsal pads work by redistributing weight away from the painful forefoot area. A metatarsal pad, when correctly placed just behind the metatarsal heads, helps separate the bones and relieve pressure on the irritated nerve.
Corticosteroid injections deliver a powerful anti-inflammatory medication directly around the nerve to reduce swelling and inflammation, often yielding short-term pain relief. While effective for symptom management, the relief from these injections is often temporary, with many patients experiencing recurrence within a few months.
An alternative is the alcohol sclerosing injection, which chemically ablates or destroys the nerve tissue. This procedure involves injecting a concentrated alcohol solution directly into the neuroma, often requiring a series of injections for success. Success rates for pain relief from alcohol injections can be high when performed under ultrasound guidance, but long-term success at five years may be lower, with some studies reporting only about 29% of patients remain completely pain-free.
Definitive Surgical Options and Long-Term Outlook
Surgical intervention becomes the definitive step when conservative management and injections do not provide satisfactory long-term relief. The most common surgical approach is a neurectomy, which involves removing the thickened portion of the nerve. This is typically performed through a dorsal (top of the foot) incision to avoid creating a painful scar on the sole of the foot.
Neurectomy generally has a high success rate, with studies reporting good-to-excellent results in the range of 76% to 85% of patients. However, a potential complication is the development of a stump neuroma, which occurs if the remaining nerve end becomes irritated or entrapped in scar tissue. This new neuroma can sometimes be more painful than the original, highlighting the importance of the surgeon retracting the nerve end into soft tissue.
A different surgical approach is nerve decompression (neurolysis), which aims to release the surrounding structures compressing the nerve. This procedure involves cutting the deep transverse metatarsal ligament, which creates more space for the nerve without removing it. The theoretical benefit is avoiding the risk of a painful stump neuroma and preserving sensation, though studies suggest its success rate for complete pain relief is slightly lower than neurectomy, at about 68%.
While the thickened nerve tissue itself does not resolve naturally, modern interventions, especially neurectomy, can definitively remove the painful structure and offer a long-term cure. The long-term outlook is generally favorable, especially when surgery is performed early after conservative treatment failure.