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It's common to feel some pain in the ball of your foot. Sometimes that pain can even shoot into your toes. My name is Dr. Andrew Schneider, and I'm a podiatrist in Houston, Texas.
If you have a pain in the ball of your foot, especially if it shoots into your toes, you may have developed a Morton's Neuroma. Morton's neuroma is an inflamed and enlarged nerve in the ball of your foot. When you hear "oma", you may think of a tumor. This is not a tumor, however, but rather an inflammation of the tissue surrounding the nerve. Complete benign, always.
The neuroma is most commonly felt in the ball of the foot, between the third and fourth metatarsal bones. The nerve gets pressure from the adjacent metatarsal bones and the ligament that's between them. Some people feel a pop or a snap, which is the nerve strumming on the ligament. Like you would pluck a guitar string.
When you have a Morton's neuroma, there's usually little externally to see. There's no swelling, redness, or bruising. Sometimes, you'll see the toes spreading apart a little more than usual. This is because of the fullness of the neuroma forcing the toes to the sides.
People suffering from a Morton's neuroma generally feel a burning pain that radiates into the toes. This pain is made worse by wearing tight shoes. That's because a tight shoe will push the metatarsal bones together and will put more pressure on the nerve. Because women generally wear more narrow shoes, women are four times more likely to develop pain from a Morton's neuroma.
When you come into the office with pain in the ball of your foot, I'll always take an x-ray. That's important to rule out other causes of pain in the ball of your foot, such as a stress fracture. During the physical examination, I'll palpate the area to see if I can and recreate the pain you feel or the "pop" you experience. I may also use diagnostic ultrasound to examine the soft tissue of the area.
Treatment for a Morton's neuroma can be both conservative and surgical. Many cases are resolved by simply changing to a wider shoe with a lower heel. Easier said than done, I know. But, if the metatarsal bone has more room to spread out, there'll be less pressure on the neuroma. Another way to shift the pressure is with the use of a custom orthotic with metatarsal support. This also serves to shift the forces away from the ball of the foot and further spreads the metatarsal bones.
To manage inflammation, I usually recommend a corticosteroid injection into the area. While this does not shrink the neuroma, it does reduce the inflammation that's causing the pain in the ball of your foot. Alternatively, we can use oral anti-inflammatory medication, but I've found an injection is much more effective.
Another treatment that's proven to be effective is shockwave therapy. During this non-invasive treatment, thousands of pulses of energy are sent into the inflamed area. This increases the blood flow to the area and allows the body to naturally heal the inflammation. There is no pain with shockwave treatments and the results lead to a more lasting pain relief.
When conservative treatment doesn't provide relief, it's time to consider surgical treatment. The surgery for a Morton's neuroma is relatively straightforward. The inflamed portion of the nerve is identified and removed. There are drawbacks for the surgery. Because a portion of the nerve is removed, it will lead to a numb sensation between the toes that it usually serves. Don't get me wrong, most people are fine with a little numb feeling instead of the pain that was there before surgery. There will also be some instability in the ball of your foot since a ligament is severed during the surgery. In most cases, I recommend the use of a custom orthotic after surgery.