Morton's neuroma

In rare cases, you might have some visible signs of Morton’s neuroma, like a lump on the bottom of your foot or discoloured skin. Usually, there are no outward signs, but you’ll have symptoms such as:

• A persistent burning and/or sharp pain in the ball of your foot that spreads out into your toes – especially when you’re doing weightbearing activities like running and/or walking
• Feelings of numbness and/or uncomfortable tingling in your toes
• Feeling like there is a marble or pebble under your foot as you walk
• If you are a sprinter or someone who plays a sport that demands rapid acceleration (football, rugby, etc.), you may feel pain in the bottom of your foot as you push off
• Problems with shoe wear, especially high-heeled shoes, which put your foot in a similar position to a sprinter’s push-off, and can make your condition worse. The same issue can occur with tight pointy shoes given how they put pressure on your toe bones and can compress your nerve

Your symptoms may begin gradually, and only be noticeable when you’re wearing narrow footwear and/or doing certain activities, like football, that put constant strain on the bottom of your feet. The discomfort may then go away after removing the shoes and/or stopping the activity. Over time, if you don’t receive treatment, your symptoms can get progressively worse and not go away for several days or weeks, becoming more intense as your neuroma gets larger.

The precise cause of Morton's neuroma is not clear, although it is generally suggested that it is most likely a consequence of compression of the nerves in your foot. Endless pressure on your nerve may lead to swelling and cause abnormal tissue (when cells grow and divide more than they usually should) to form in and around one of your digital plantar nerves. This pressure can be a result of many factors, such as:

Foot shape

If you were born with a certain foot shape, like flat feet (when the arch at the bottom of your foot is not there), high arches, or when your first metatarsal (the long bone in your foot that connects your ankle and toe) is shorter than the one next to it, you may be at greater risk of developing Morton's neuroma. By having a flat foot shape, you may increase the amount of pressure that goes through your metatarsals and/or toes, making it more likely for a neuroma to form.

Medical conditions

There are certain medical conditions that increase the chances of you developing Morton's neuroma. These include:

• Bunions (a bony bump on the side of your feet next to your big toe, caused by the tip of your big toe being pulled toward your smaller ones and leading to the joint at the base of your toe sticking out)
• Hammer toe (a deformity that causes your toe to curl downward instead of pointing forward and develops over time due to arthritis or wearing poorly fitting shoes)

Sports

If you participate in any intense high-impact athletic activities (running, sprinting, football, tennis, etc) that involve constant pressure being placed on the ball of your foot, the relentless strain on the bottom of your foot can lead to the thickening and swelling of the nerves in the bottom of your feet and ultimately cause Morton's neuroma. This is more likely if you don't properly rest your foot after exercise.

Shoe choice

Wearing shoes with high heels (more than two inches high), or shoes that are tight-fitting, narrow, or have a pointed toe (ballet shoes, ski boots, etc), put extra pressure on the balls of your feet and limit how much you can move your toe¹. When this happens, the excessive pressure on the front of your foot can damage the nerve tissue between your toe bones, leading to Morton's neuroma.

Your consultant will begin by asking some basic questions about your symptoms, such as what kind of pain you're having, when it started, what shoes you wear, along with making a note of your work, physical activities, and general lifestyle. They may then do a series of tests, which could include:

Physical examination

A physical examination is an important aspect of understanding whether the location and nature of your pain fits with the symptoms of Morton's neuroma. To do this, your consultant will press on your foot to check for where and when you feel discomfort, and check the position of your toes and/or foot for common deformities (which may be a cause of your pain), along with noting any clicking between your toes, which can be a sign of Morton's neuroma. This may also be accompanied by a range of motion test, with your consultant moving your foot and toe around to see if arthritis or joint inflammation is the cause of your foot pain.

X-ray

Although X-rays do not generate images of nerve tissue damage, meaning they won't be able to diagnose Morton's neuroma through this test, it will allow them to rule out any fractures to the bones in your foot.

Ultrasound and/or MRI

These tests use sound waves or magnetic waves to generate detailed images of your soft tissue (muscles, tendons, ligaments) and your surrounding nerve tissue. It allows them to see whether any thickening and inflammation has occurred in any of the nerves between the bones in your feet. They should be able to confirm if you have Morton's neuroma by doing one or both of these imaging tests.

If your consultant determines that your Morton's neuroma is only mild or moderate, and you've not had the issue for a long time, they will recommend a series of non-surgical treatments. Some of these may include:

Rest and/or modified activity

The first thing your consultant may ask you to do is rest the affected area and avoid the same movements that contributed to the development of your Morton's neuroma in the first place. In some cases, giving your foot a good amount of time to rest can be enough to bring down the inflammation around your nerve tissue and alleviate your symptoms.

Change your footwear

If you constantly wear high heels or shoes that are narrow and/or pointy, your consultant may recommend changing to wider shoes with lower heels and a softer sole. Making this change in the shoes that you wear will mean that your bones have the chance to spread out and, as a result, may reduce the amount of pressure on the nerve that has thickened and is causing you pain, allowing for sufficient time to heal.

Orthotics

Your consultant may recommend that you use orthotics - padded shoe inserts that are placed into your shoes and designed to distribute pressure evenly when you move your feet, which in turn brings down the level of pressure on your forefoot and the nerves between your toes. Over time, this can separate the bones, which in turn reduces the pressure placed on your neuroma.

Injections

You might be given one or more injections of a corticosteroid medication (highly effective steroids that reduce the levels of swelling in your inflamed nerve), which can bring you relief from your discomfort. Your consultant may also decide to use a nerve ablation injection, which is when they inject a medication into your foot that permanently stops your nerve from sending out pain signals.

Extreme cold

Another treatment for Morton's neuroma, which may be used before an operation or as a treatment on its own, involves using extreme cold - known as cryogenic neuroablation. Putting your foot under severe low temperature in this way can destroy some of the nerve cells that have built up around the bones in your toes, along with the layer that protects them (your myelin sheath). Usually, treatment temperature goes down to around 70 degrees below Celsius.

If your Morton's neuroma is severe, and conservative treatments have not made any difference to your situation, your consultant may recommend surgery. This will usually involve a procedure known as a neurectomy.

Anaesthesia

A neurectomy is commonly performed under general anaesthesia, which means you'll be asleep for the entire operation and won't feel anything. The operation takes anywhere between 15 and 30 minutes. We also offer spinal anaesthesia, during which an injection is made into the base of your spine and removes all sensation in your lower body. You will be awake for the duration of the surgery. Your anaesthetist shall speak to you about your preferred anaesthesia option prior to your procedure.

Neurectomy

During a neurectomy, your surgeon removes the diseased nerve tissue of the plantar nerve in your forefoot. To do this, they will start by making a small incision between your toes, giving them access to the affected tissue. Your surgeon then opens up the band of connective tissue over your metatarsal head (the top of your metatarsal bone), which releases pressure on your compressed nerve, and/or removes a portion of your nerve itself, which will lead to the area between your toes becoming permanently numb.² Once there is no pressure on your metatarsal bone and your nerve has sufficient space to pass through your foot, your surgeon will close up the wound and cover it in a protective dressing.

Surgery for Morton's neuroma is done on an outpatient basis, so you'll be able to go home on the same day. We will provide you with pain relief medication for you to take as you recover from the treatment. Driving and/or public transport won't be an option immediately after surgery, so please take care to arrange a lift back home either via a taxi or with a family member or friend. For the first week, you should rest your foot as much as possible, keeping it elevated and putting ice on the affected area.

After surgery, your nurse will put a special shoe onto the affected area that ensures you don't put any pressure on your forefoot. This typically needs to be worn for two to three weeks, and you'll need to use crutches to get around. If your job doesn't involve putting any weight on your foot (e.g. a desk job), you should be able to return to work after a week. As a manual worker, your time away from work will be more like four to six weeks.

After the three-week period of wearing a forefoot offloading shoe, you can return to normal footwear with a flat sole. This is important, as it supports the arch of your foot and ensures your toes don't get pushed together. You should be able to return to driving at this point, as long as you don't feel any discomfort when you drive and can safely do an emergency stop.

For the first two months after your Morton's neuroma surgery, avoid heavier strain on the area and rolling your foot. You should, from this point onwards, be able to return to physical activity, starting with light exercises ahead of eventually moving back to full exertion. Your physiotherapist can work with you on a tailored recovery programme and let you know when you are able to go back to sports and activities such as football or running.

Like with any surgery, it is possible for some complications to occur, but these are extremely rare. Your consultant will take time to explain all the risks to you before booking you in for surgery, ahead of answering any questions that you may have.

General complications of any operation

• Pain
• Bleeding
• Infection in the surgical wound
• Unsightly scarring
• Blood clots
• Difficulty passing urine
• Chest infection
• Heart attack or stroke

Specific complications of Morton's neuroma surgery

• Stump neuroma formation (the problem can get worse and becomes harder to treat than the original problem)
• Pain in the ball of your foot despite surgery
• Floating toe (your toe does not touch the ground)
• Loss of sensation between your toes
• Haematoma (when blood collects under your skin)
• Nerve pain and/or damage

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations that suit your schedule
• The freedom to choose which hospital and consultant fit your needs
• Personalised, consultant-led treatment plans tailored to your requirements
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private cosy ensuite rooms as standards and delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about surgery for Morton's neuroma, or other conditions causing discomfort in your feet, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in November 2022. Next review due November 2025.

1. Morton’s neuroma, WebMD
2. Morton’s neuroma, Cleveland Clinic
3. Morton’s neuroma, OrthoInfo
4. Morton’s neuroma, Mayo Clinic
5. Morton’s neuroma surgery, OS Clinic