Morton's neuroma

Morton's neuroma is a painful foot condition caused by thickening and irritation of a nerve between your toes, usually the third and fourth. Despite its name, it isn't actually a tumour, and the symptoms can often be eased with treatments you can try yourself.

Symptoms of Morton's neuroma

The main symptoms of Morton's neuroma include:

• a shooting, stabbing or burning pain between your toes, most often the 3rd and 4th
• a feeling like there's a pebble, marble or lump stuck under your foot
• tingling, pins and needles, or numbness in your toes
• a clicking sensation in your foot.

Symptoms are usually worse when you stand, walk, or wear tight or high-heeled shoes, and often ease when you take your shoes off and rest or massage your foot.

Symptoms usually get worse over time. You may notice only minor, occasional pain at first, but as the nerve becomes more irritated, you may feel sharp, shooting pains even without putting weight on your foot.

Causes of Morton's neuroma and who is at risk

Morton's neuroma is caused by an irritated or damaged nerve between your toe bones. The exact cause isn't fully understood, but repeated pressure or stress on the nerve is thought to play a key role.

It's often linked to:

• wearing tight, narrow, pointy or high-heeled shoes, especially combined with thin, hard soles
• running or other sports and activities that put pressure on the ball of your foot
• a sudden increase in how much time you spend standing, walking or running
• having other foot problems, such as flat feet, high arches, bunions or hammer toes
• carrying excess weight
• tight calf muscles
• inflammatory conditions, such as rheumatoid arthritis
• a previous foot injury.

Morton's neuroma is more common in women, often linked to footwear choices, and can affect adults of almost any age, though it's most frequently diagnosed in people between their late twenties and sixties.

Are there different types of Morton's neuroma?

Morton's neuroma is usually described by which nerve, and therefore which toes, it affects. It most commonly develops between the 3rd and 4th toes. Less often, it can affect the nerve between the 2nd and 3rd toes, or, rarely, the 4th and 5th. You can also have more than one neuroma at a time, sometimes in both feet.

How Morton's neuroma is diagnosed

A doctor or foot specialist, such as a podiatrist, will usually start by examining your foot and asking about your symptoms. They may gently squeeze the ball of your foot between the metatarsal bones, feeling for a lump and checking whether this reproduces your pain, sometimes alongside a clicking sensation.

Imaging isn't always needed, as Morton's neuroma is often diagnosed from your symptoms and examination alone. However, an X-ray may be used to rule out other causes of foot pain, such as a stress fracture or arthritis, since it won't actually show the neuroma itself.

An ultrasound scan can help visualise the thickened nerve directly, and is often the preferred imaging test. An MRI scan is occasionally used if the diagnosis remains unclear.

How Morton's neuroma is treated

Treatment usually starts with things you can try yourself. These include:

• wearing wide, comfortable shoes with a low heel, soft sole and roomy toe box
• using soft insoles, cushioned pads, or a metatarsal pad placed just behind the ball of your foot
• resting and raising your foot when you can
• taking ibuprofen or paracetamol
• losing weight if you're overweight
• avoiding or cutting down on high-impact activities, such as running and jumping
• stretching your calf muscles.

If self-care isn't enough, a foot specialist may recommend specially made insoles or pads, or a steroid injection into the area around the nerve, which can relieve pain in some cases and also helps confirm the diagnosis.

Surgery is only considered if other treatments haven't worked and the pain is significantly affecting your daily life. The most common operation, called a neurectomy, removes the affected part of the nerve, with a success rate of around 80%. This does leave some permanent numbness in the toes on either side of the treated nerve, and in a small number of people, persistent pain can develop at the cut end of the nerve, which may need further treatment.

Other, less common surgical options use extreme cold or heat to destroy the affected nerve tissue instead of removing it.

When to see a doctor

See a GP if:

• the pain in your foot is severe, or is stopping you doing your normal activities
• the pain is getting worse or keeps coming back
• your symptoms haven't improved after trying self-care for 2 weeks
• you have tingling, weakness or numbness in your foot
• you develop foot pain after a recent injury, or foot or ankle surgery.