You have been doing your usual running or workout regimen, or perhaps you have some really hot new high heeled shoes that you just love to wear to the office.  Problem is recently you have been feeling like a “sock is bunched up” under your 2nd and or your 3rd toes.  You have to stop what you are doing and by rubbing your toes, it feels a little better, but still the pain persists.  You wonder what is wrong but keep doing what you have been doing figuring it will go away.


mortons neuroma

Mortons Neuroma- It Feels Like There is Something in My Shoe

You my friend are now the proud owner of what is called a “Mortons Neuroma”.  Basically what it is is a compressed or irritated nerve. They can be caused by tight shoes, worn out or run over running shoes (or even street shoes). It can also be caused by what is known as “pronation” of your foot.  The nerve innervation to the feet comes from the bottom of your feet, and the plantar nerves “split off” to give sensation to either side of adjoining toes. (Imagine if you will, the nerves are traveling to your toes and when it reaches the base of your toes, it splits off and looks like the letter ‘Y” and goes to innervate adjoining sides of adjoining toes.)

What happens when you are walking or running is that this part of the nerve (the bifurcation) gets squeezed between the 2 adjoining metatarsal heads, and thus you have pain.  Nerve pain can come about very quickly, but even with treatment can take weeks or even months to resolve.

How to Treat a Mortons Neuroma

What can be done? First and foremost, make sure your shoes are not worn out, or too tight in the front of the shoes.  Failing that, you would require a visit to your local friendly Podiatrist for an exam and evaluation. (There are other things that must be ruled out as the pain causing entity. Such as stress fracture, capsulitis, contusion and the like…Don’t try and diagnose via the internet.  The sooner you get proper evaluation and diagnoses, the quicker you will get back to your normal daily activities in your previous pain free condition.

When all other thing have been ruled out a neuroma is usually treated first by a steroid injection (to quiet down the inflammation of the offending nerve) and plantar strapping to lessen the pronation of your foot, Your doctor might also use a prescription of N-saids to help decrease the inflammation of the nerve. The next step would be, to be fitted for a functional orthotic which would on a regular basis, help prevent the pronation that caused your neuroma in the first place.  Of course you might need to change your shoe style if it determined that this was the cause of the irritation.

There are other treatment should the above mentioned treatments fail to give the relief you have hoped for. Cryotherapy and surgery are always options that can and should be considered with recalcitrant neuromas. Simple treatment for a simple but very painful and activity limiting problem.  

Robert Kosofsky, D.P.M.
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Dr. Robert Kosofsky has over 25 years of experience treating patients in our Hillsborough & Piscataway offices
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