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PATHOLOGIES
FOREFOOT CONDITIONS
Morton’s Neuroma (Interdigital Neuroma)
What is it?
Morton’s neuroma is a painful swelling or thickening of a digital nerve, usually between the 3rd and 4th toes (third intermetatarsal space). It is not a true tumor, but rather a benign enlargement of the nerve due to chronic irritation or compression.
CAUSES
- Repetitive compression of the nerve, often due to:
- Tight or narrow footwear (especially high heels)
- Excessive forefoot loading during walking or running
- Foot biomechanics:
- Flatfoot or hyperpronation
- High-arched (cavus) feet
- Associated deformities like bunions or hammer toes
SYMPTOMS
- Burning, tingling, or numbness in the forefoot
- Pain radiating into the toes (especially 3rd and 4th)
- A sensation of “walking on a pebble” or “folded sock”
- Symptoms often worsen with walking, tight shoes, or prolonged standing
- Relief when removing shoes or massaging the foot
DIAGNOSIS
- Clinical exam: Includes palpation of the intermetatarsal space, Mulder’s click test (palpable click when compressing forefoot)
- Ultrasound or MRI: Can confirm nerve thickening or exclude other causes
- Diagnostic injection: Local anaesthetic may help confirm the diagnosis and relieve symptoms
TREATMENT OPTIONS
Non-Surgical
- Footwear modification: Wider toe boxes, low heels
- Metatarsal pads or custom orthotics to offload the nerve (not very effective)
- Activity modification
- NSAIDs to reduce inflammation
- Corticosteroid injections – can provide temporary relief
Surgical
- Considered if symptoms persist despite conservative treatment
- Options:
- Neurectomy – surgical removal of the affected nerve segment
- Decompression – release of surrounding ligaments without nerve excision
- Surgery typically has a high success rate, but may result in permanent numbness between the affected toes
PROGNOSIS
- Many patients improve with non-surgical care, especially with early diagnosis
- Surgery is generally effective for persistent cases but carries risks of altered sensation
