Morton Neuroma • Metatarsal nerve pain

A Morton’s neuroma is an inflammatory thickening of the metatarsal nerves. It is triggered by overuse and is accompanied by severe pain in the metatarsus and toes. Shoe inserts, physiotherapy, and/or cortisone injections often provide relief, and minor surgery may be necessary in some cases.

: © Getty Images/Suriyawut Suriya/EyeEm

At a glance:

Foot pain: The seven most common foot problems

What is a Morton’s neuroma?

A Morton’s neuroma (also called Morton’s syndrome, Morton’s neuralgia or Morton’s metatarsalgia) is a thickening of the nerves between the metatarsal bones caused by overuse. It is the most common cause of chronic metatarsal pain and occurs mostly in middle age, and in runners often as early as 20 years of age. In about 20 percent of cases, both feet are affected, and Morton’s neuroma occurs much more frequently in women than in men.

A Morton’s neuroma is associated with these symptoms

People with Morton’s neuroma usually complain of burning or stabbing pain under the soles of the feet or in the metatarsals, which can radiate to the toes. In most cases, the pain center is between the third and fourth toe, less often between the second and third toe. The pain usually only occurs under load and/or in tight shoes and subsides significantly when the shoes are removed. Some sufferers describe a foreign body sensation under or a tingling or numbness in the toes. With advanced Morton’s neuroma, palpable nodules sometimes form in the affected area.

Causes of Morton’s Neuroma

The space between the third and fourth toes is particularly narrow and difficult to move when walking, the nerves here are exposed to a very high level of stress. Wearing high and tight shoes increases this burden even more – especially if there is already a congenital deformity of the metatarsal bones.

At a so-called splayfoot During the normal rolling movement of the foot, a particularly high pressure is exerted on the nerves – as a reaction, their connective tissue covering swells, pinches the nerve further and causes pain and numbness. If this swelling lasts longer, the connective tissue begins to proliferate, becomes firmer (fibrosis) and eventually forms a palpable knot.

The risk of developing a Morton’s neuroma therefore always increases when the forefoot is subjected to particular stress:

when wearing high and pointed shoes
due to congenital deformities of the foot
through extreme running training
through overweight

Runners who switch from heel to forefoot running are also often affected by Morton’s neuroma. Morton’s neuroma can also occur after an ankle injury because the foot is affected by restricted motion that increases compressive stress on the forefoot.

Diagnosis: This is how a Morton neuroma is diagnosed

Due to the typical symptoms, the suspicion of a Morton neuroma can often arise from the descriptions of the person concerned. In this case, a palpation examination of the foot is carried out in the doctor’s office: This usually shows severe tenderness in the middle and forefoot. The so-called Mulder click phenomenon provides additional clarity: when the metatarsal heads are pressed together, a clear click or snap can be felt.

Larger Morton neuromas can be felt as hardening between the toe bones – these are also in the Ultrasonic or MRT visible. To confirm the diagnosis, a local anesthetic is sometimes injected into the nerve: If the pain has disappeared or significantly reduced during its effect, the diagnosis of Morton’s neuroma is considered confirmed.

Therapy: This is how a Morton neuroma is treated

Any treatment for a Morton’s neuroma is aimed at relieving the pressure on the affected areas and therefore on the nerves. This means first and foremost doing without high and tight shoes and – if any splayfoot The trigger of Morton’s neuroma is – the supply of specially adapted shoe inserts. Wearing wide shoes is also helpful in order not to constrict your feet any further. In many cases, this already brings about a significant alleviation of the symptoms. Complementary come often cortisone--Injections are used, but these are not suitable for long-term therapy due to their long-term side effects.

If these measures do not help, a special one is often used physical therapy prescribed to strengthen the small muscles of the feet. Self-help exercises are taught here that can be continued independently at home. Shockwave therapy can also help.

Course and duration of Morton’s neuroma

Morton’s neuroma needs to be treated, otherwise it becomes chronic and causes constant pain.

If none of these measures help (about two-thirds of those affected) and the symptoms severely impede everyday life, an operation may be necessary. The affected nerve is either completely removed or relieved by removing the proliferating tissue. In some cases, the foot malposition underlying the Morton’s neuroma is also surgically corrected. After the operation, a special shoe that relieves the forefoot must be worn for two to three weeks.

The operation cures the symptoms for 70 to 90 percent of those affected. A recurrence of a Morton’s neuroma in the same place does not occur.