Morton’s neuroma involves the thickening of tissue around a nerve in the foot, most commonly between the third and fourth toes. Its symptoms can be confused with other foot ailments, making accurate diagnosis challenging. Understanding its characteristics and those of similar conditions is important for effective treatment.
Understanding Morton’s Neuroma Symptoms
Morton’s neuroma causes sharp, burning pain in the ball of the foot, often radiating into the toes. Patients may experience numbness, tingling, or a sensation like walking on a pebble or a bunched-up sock. This discomfort worsens with activity, such as walking or running, and when wearing tight or high-heeled shoes. Relief is found by removing footwear and massaging the affected area, though persistent symptoms can lead to chronic discomfort.
The pain is concentrated behind and between the third and fourth toes, though it can also occur between the second and third toes. Over time, the nerve inflammation can increase, potentially leading to permanent nerve damage. While often painful, Morton’s neuroma does not present with outward signs like a visible lump or discoloration.
Other Conditions with Similar Foot Pain
Many conditions can mimic the symptoms of Morton’s neuroma due to overlapping pain patterns in the forefoot. Differentiating them requires careful consideration of their characteristics.
Metatarsalgia
Metatarsalgia refers to pain and inflammation in the ball of the foot. This condition can cause a sharp, aching, or burning sensation, sometimes accompanied by numbness or tingling in the toes. Patients often describe a feeling like walking on a pebble, similar to Morton’s neuroma. Unlike Morton’s neuroma, metatarsalgia pain may affect a broader area across the forefoot and is caused by overuse, ill-fitting shoes, or foot deformities, without nerve thickening.
Stress Fracture
A stress fracture is a small crack in a bone, often occurring in the metatarsals of the foot. The pain develops gradually and worsens with weight-bearing activities, such as running or walking. This localized pain subsides with rest, which helps distinguish it from the persistent nerve pain of a neuroma. Swelling, tenderness, and bruising may also be present on the top of the foot or ankle.
Intermetatarsal Bursitis
Intermetatarsal bursitis involves inflammation of the bursa, a fluid-filled sac located between the metatarsal bones. Symptoms include pain in the ball of the foot, which worsens with activity or pressure. This condition can also cause swelling and tenderness between the affected metatarsal bones, leading to difficulty walking. While similar to a neuroma in pain location, bursitis is characterized by inflammation of the bursa rather than nerve thickening.
Plantar Plate Tear
A plantar plate tear is an injury to the ligament on the bottom of the foot at the base of the toes, most often affecting the second toe. Symptoms include persistent pain and swelling under the ball of the foot, extending towards the toes. The pain increases when bending the toe upwards, and in more advanced cases, the affected toe may drift upwards or sideways, sometimes creating a “V” shape between the toes. This toe deformity is a distinguishing feature not seen with Morton’s neuroma.
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome results from the compression of the posterior tibial nerve as it passes through the tarsal tunnel in the ankle. This condition can cause pain, burning, tingling, or numbness that radiates into the foot, sometimes mimicking forefoot nerve issues. Symptoms are felt on the inside of the ankle or on the bottom of the foot, and may extend to the heel, arch, or toes. Unlike Morton’s neuroma, which is localized to the forefoot, tarsal tunnel syndrome originates at the ankle.
Ganglion Cyst
A ganglion cyst is a non-cancerous, fluid-filled lump that can form near joints or tendons, including those in the foot. While often painless, if it presses on a nerve, it can cause tingling or burning. If it presses against a joint or tendon, it may cause a dull ache. The presence of a palpable lump is a distinct characteristic of a ganglion cyst not typical of Morton’s neuroma.
How Doctors Diagnose Foot Conditions
Doctors employ a systematic approach to accurately diagnose foot conditions, combining patient history, physical examination, and various imaging tests. This comprehensive evaluation helps differentiate Morton’s neuroma from other conditions with similar symptoms.
During a physical examination, the doctor will inquire about the onset, location, and nature of the pain, as well as factors that worsen or alleviate symptoms. A specific test called Mulder’s click involves squeezing the sides of the foot to compress the nerve between the metatarsal bones. If this maneuver produces a sharp pain or a palpable click, it can indicate the presence of a neuroma. The doctor may also palpate (press) between the toes to check for tenderness and locate the affected nerve.
Imaging tests are used to confirm a diagnosis and rule out other potential causes of foot pain. X-rays are performed first to exclude bone abnormalities like fractures or arthritis, though they do not show neuromas. Ultrasound can visualize soft tissues and nerve thickening, providing a clear image of the neuroma. Magnetic resonance imaging (MRI) provides detailed images of both soft tissue and nerves, making it a reliable method for diagnosing neuromas and differentiating them from other conditions. Nerve conduction studies may also be conducted to assess nerve and muscle function and rule out other nerve-related conditions.
When to Consult a Doctor
Seeking professional medical attention is advisable if you experience persistent foot pain, numbness, or tingling, especially if these symptoms interfere with your daily activities. Self-diagnosis can be misleading due to overlapping symptoms. A healthcare professional can provide an accurate diagnosis through examination and diagnostic tests. Early diagnosis allows for an effective treatment plan, preventing symptoms from worsening and reducing the risk of long-term complications.