MORTON'S NEURALGIA
Pain between the toes?
Morton's neuralgia – also known as a Morton's neuroma – is a painful irritation of a nerve in the foot in the area between the toes, usually between the third and fourth toe. It involves chronic compression and thickening of the plantar common digital nerve, which is irritated by repeated pressure or friction.
How does a Morton's neuroma develop?
Morton's neuralgia is caused by chronic irritation of a sensory nerve branch (the common digital nerve), which runs between the metatarsal bones in a narrow canal of connective tissue. This nerve supplies sensation to the adjacent toes. Repeated mechanical loading – particularly in combination with unfavourable foot mechanics – can lead to local damage.
- Tight or high-heeled shoes, which constrict the forefoot and compress the nerves between the metatarsal heads
- A splay foot deformity, in which the midfoot widens and the nerve has less room
- Overpronation or abnormal loading when walking and running, often caused by unsuitable shoes or intensive sporting activity
- Repeated microtrauma, for instance when jogging on hard surfaces
Symptoms
The symptoms of Morton's neuralgia usually develop gradually and at first only occur under load. As the irritation progresses, the pain can persist during periods of rest as well.
Pain
Burning, stabbing or electric pain in the forefoot, particularly between the third and fourth metatarsal
Numbness
Paraesthesia such as tingling, pins and needles or numbness in the adjacent toes – usually the third and fourth toe, less often the second and third.
Mulder's sign
Firm pressure on the space between the toes can produce a snapping or clicking sound – with brief but characteristic pain
Treating Morton's neuralgia
Treatment of Morton's neuralgia (Morton's neuroma) depends on the extent of the symptoms and the stage of nerve irritation, as well as on individual factors such as the shape of the foot, the loads placed on it and your occupation. The aim is to take pressure off the affected nerve, relieve the pain and prevent the condition from becoming chronic.
Treatment options
Non-surgical and surgical – we will find the right approach for you
Adapting footwear
Wearing flat, wide shoes with a generous forefoot area, to avoid mechanical pressure
Insoles
Orthopaedic insoles with a metatarsal pad, which take pressure off the space between the toes by spreading the metatarsal bones
Physiotherapy
Mobilisation of the metatarsal joints and stabilisation where foot mechanics are unfavourable, particularly with a splay foot or a flat foot with valgus
Pain relief and anti-inflammatory treatment
Taking NSAIDs such as ibuprofen or diclofenac to treat the symptoms
Shockwave therapy (focused extracorporeal shockwave)
Extracorporeal shockwave therapy (ESWT) is used off-label for Morton's neuralgia – that is, it is not primarily licensed for this indication, but it is being used increasingly. There are a number of smaller studies and clinical reports showing pain relief when it is used at an early stage.
Neurolysis (nerve decompression)
In a neurolysis the nerve is not removed but freed from the constricting connective tissue that surrounds it.
Nerve resection (neurectomy)
Nerve resection is the standard procedure for pronounced Morton's neuralgia. The thickened interdigital nerve, including the neuroma, is removed completely through an approach from the top of the foot. To prevent a stump neuroma, the proximal end of the nerve is embedded in deeper, well-perfused layers of tissue ("buried").
Frequently asked questions about Morton's neuralgia
What exactly is a Morton's neuroma?
Which symptoms are typical?
How is Morton's neuralgia diagnosed?
Can a Morton's neuroma be treated without surgery?
When is surgery worthwhile?
Our foot specialists
Experienced consultants for Morton's neuralgia and foot surgery
