Morton’s neuroma is a painful condition that affects the digital nerve in the forefoot, most commonly the nerve running between the third and fourth toes. It is not a true tumor but rather a thickening and irritation of the nerve tissue, which causes discomfort often described as feeling like walking on a marble or pebble. This nerve compression typically occurs where the nerve passes under the ligament connecting the metatarsal bones, leading to burning pain, numbness, and tingling. Addressing the pain involves a progressive strategy, beginning with immediate self-care adjustments before moving to clinical interventions.
Foundational Mechanical Adjustments
Relief begins with eliminating the mechanical compression irritating the nerve. The most accessible starting point is changing footwear, specifically choosing shoes with a wide toe box and a low heel. Narrow shoes and high heels force the forefoot bones together, squeezing the nerve and worsening symptoms.
Supportive devices can redistribute pressure away from the painful area in the ball of the foot. Metatarsal pads, which are teardrop-shaped cushions, are placed just behind the heads of the metatarsal bones, not directly under the neuroma itself. This specific placement helps to gently separate the metatarsal heads, thereby decompressing the nerve as the foot bears weight.
For acute flare-ups, simple self-care steps can help manage immediate discomfort and nerve swelling. Resting the foot by avoiding activities that aggravate the pain, such as high-impact sports, allows the inflamed nerve to calm down. Applying ice massage to the affected area can also reduce local swelling and provide temporary pain relief.
Pharmacological Relief and Directed Physical Therapy
When mechanical adjustments alone are insufficient, pain and inflammation can be addressed using pharmaceutical agents. Over-the-counter (OTC) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen or naproxen, can reduce the inflammation and swelling around the affected nerve. These medications are most effective when taken for a short period to manage acute symptoms, but long-term use should be discussed with a healthcare provider.
Physical therapy addresses underlying biomechanical factors contributing to the neuroma. Stretching the Achilles tendon and calf muscles is often recommended because tightness in these areas can alter gait mechanics and increase pressure on the forefoot. Exercises that improve foot mobility and strengthen ankle muscles also provide greater stability, minimizing repetitive trauma on the nerve.
For more structured support, custom orthotics provide superior biomechanical correction compared to generic insoles. These devices are molded to the individual foot, ensuring precise placement of features like a metatarsal pad to optimally lift and separate the metatarsal bones. By addressing specific foot mechanics, custom orthotics can prevent the excessive movement and compression that often lead to nerve irritation.
Advanced Clinical Interventions
If conservative measures fail to provide lasting relief after several months, injection therapy is a common next step. Corticosteroid injections are often used to deliver a potent anti-inflammatory agent directly to the site of the neuroma. These injections, frequently performed with ultrasound guidance for accuracy, aim to significantly reduce nerve swelling and pain.
Another injection option is alcohol sclerosing, which involves injecting a chemical solution to intentionally damage or shrink the nerve tissue. This is a form of chemical ablation intended to disable the nerve’s ability to transmit pain signals. Both injection types can offer temporary relief and may be repeated, though success rates can vary among individuals.
When chronic pain remains unmanageable, surgical intervention, typically a neurectomy, may be considered. This procedure involves removing the damaged section of the nerve, which usually results in permanent numbness between the affected toes. The surgery is generally a day-case procedure, requiring patients to wear a protective surgical shoe for several weeks, with a return to most activities possible within three months. A small percentage of patients may experience persistent pain after surgery due to the formation of a stump neuroma at the cut end of the nerve.