If it feels like you are stepping on a pebble and you have pain on the ball of your foot along with numbness or tingling in your toes, you may have what is called a Morton’s neuroma. A morton’s neuroma is a thickening of tissue that surrounds the interdigital nerve that leads to the toes.
The cause of a neuroma is not fully understood but may come from trauma to the foot, irritation or compression of the forefoot. It is most common in between the third and fourth toes, but can occur in between the second and third toes as well. It is more common in women.
Patients may have pain with walking, wearing high heels or wearing narrow shoes. They may feel like they are walking on a pebble or a marble. They may have a burning sensation on the ball of the foot that radiates to the toes. Pain may be relieved after taking shoes off or massaging the foot. Numbness or tingling may be present in the toes or on the bottom part of the foot.
A neuroma may be palpated on exam and may be tender to palpation. A click may be reproduced when the sides of the foot are squeezed together. Sensation may be decreased along the length of the nerve or in the toes. Standing x-rays are taken to evaluate for stress fractures or arthritis in the foot. A neuroma is not seen on x-ray.
Treatment includes shoe modification, metatarsal pads, cortisone injection or surgery. Patients should avoid wearing high heels and tight shoes, which squeeze the foot together and put more pressure on the nerve. Metatarsal pads help to relieve the pressure on the nerve by lifting and separating the bones. A cortisone injection (localized dose of anti-inflammatory) may be given once to help decrease the inflammation and swelling around the nerve. If shoe modification and a cortisone injection doesn’t work, then surgery is that last option. During surgery the neuroma is removed (called a neurectomy). After surgery patients can walk right away in a postop shoe for 2 weeks. Patients may have permanent numbness or tingling in their toes after the surgery.