Morton’s neuroma is a painful condition affecting the ball of the foot, characterized by a thickening of the tissue surrounding one of the nerves leading to the toes. This enlargement most often occurs between the third and fourth toes, where the nerve is subjected to compression. Symptoms commonly include a sharp, burning pain, tingling, or a sensation that you are walking on a pebble or a bunched-up sock beneath the forefoot. If left unaddressed, this nerve irritation can progressively worsen, making simple activities like walking difficult. Treatment involves a progressive approach, starting with the least invasive methods and escalating to targeted treatments to eliminate symptoms.
Initial Non-Invasive Management
Initial management involves conservative changes designed to reduce pressure and irritation on the affected nerve. Modifying footwear is the most impactful step, requiring a switch to shoes with a wide toe box to allow the toes to spread naturally. Avoiding high-heeled shoes is also necessary, as they force weight onto the forefoot, increasing pressure.
Low-heeled shoes, ideally two inches or lower, help redistribute weight more evenly across the foot. Metatarsal pads or custom orthotics can alleviate discomfort by lifting and separating the metatarsal heads. These devices offload pressure from the nerve, offering targeted support.
Temporary relief can be achieved through applying ice to the affected area, which reduces localized swelling. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) manage the burning pain and reduce the nerve’s inflammatory response. These simple adjustments are foundational, and in many mild cases, they provide sufficient long-term relief.
Targeted Non-Surgical Procedures
When conservative measures fail to provide lasting relief, medical professionals administer targeted procedures. Corticosteroid injections are a common next step, delivering anti-inflammatory medication directly around the irritated nerve. This rapidly decreases swelling and inflammation, reducing pressure on the nerve and offering pain relief lasting several weeks to months.
Alcohol sclerosing injections involve injecting a solution of concentrated alcohol into the neuroma area over several sessions. This chemical ablation process selectively destroys the nerve tissue, hindering its ability to transmit pain signals. This minimally invasive treatment is viable for patients who have not responded to anti-inflammatory injections.
Cryotherapy, or cryoablation, is an alternative technique that uses extreme cold to destroy the nerve tissue. A probe is inserted near the neuroma to freeze the nerve, causing degeneration and preventing pain transmission. These procedures are often performed under ultrasound guidance to ensure precise delivery, increasing efficacy and minimizing risk to healthy tissue.
Surgical Options for Nerve Relief
If non-surgical treatments fail to resolve chronic pain, surgery becomes the definitive option by directly addressing the thickened nerve. The most common approach is a neurectomy, which involves the removal of the affected nerve segment. The goal is to permanently eliminate the source of pain, but it results in permanent numbness in the area between the affected toes.
A less aggressive approach is nerve decompression surgery, also known as neurolysis. This procedure relieves pressure surrounding the nerve, typically by cutting the transverse metatarsal ligament. Releasing this tight band of tissue alleviates chronic compression, giving the nerve more space. This option is often considered for smaller neuromas and attempts to preserve nerve sensation.
The decision between neurectomy and decompression often depends on the size of the neuroma and the duration of symptoms. Both procedures are generally performed through an incision on the top of the foot. While surgical intervention has high success rates, there is a risk of a recurrent neuroma or a painful stump neuroma forming at the site of removal.
Preventing Recurrence and Long-Term Care
Maintaining a pain-free life after successful treatment requires ongoing attention to foot mechanics and footwear. The most important long-term strategy is the continued use of shoes with a wide toe box and low heels, avoiding any style that compresses the forefoot. This practice ensures the interdigital nerve space remains uncrowded, reducing the chance of irritation and thickening.
Patients should continue to use custom orthotics or metatarsal pads to maintain proper foot alignment and pressure redistribution across the metatarsal bones. Incorporating gentle stretching and foot-strengthening exercises into a daily routine helps maintain flexibility and muscle support around the foot arch. Monitoring the forefoot for any return of tingling, burning, or discomfort allows for early intervention.