Neuroma (Morton's Neuroma)
A burning, cramping pain between your toes that feels like a pebble stuck in your shoe. Shockwave therapy reduces the inflammation compressing the nerve and can significantly decrease pain in cases where conservative treatments have fallen short.
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A neuroma is a thickening and irritation of the nerve that runs between the toes — most often between the 3rd and 4th toes. It's not a tumor; it's more like a pinched or scarred nerve.
It develops when the nerve is repeatedly compressed or irritated. Tight, narrow, or high-heeled shoes are a leading cause because they squeeze the forefoot. High-impact activities like running can also contribute, especially with poor foot mechanics. People with flat feet or high arches are more prone to developing neuromas.
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Your doctor will press between your metatarsal bones (the long bones leading to your toes) to reproduce your pain. A click may be felt when the nerve is compressed and released — this is called a Mulder's sign and is a strong indicator of a neuroma.
An X-ray rules out a stress fracture or bone problem. Ultrasound can visualize the neuroma directly and is often the most practical imaging choice. MRI is occasionally used for complex or uncertain cases. A diagnostic injection of local anesthetic is sometimes used — if it relieves your pain, it confirms the location.
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The first steps are wider shoes with a lower heel, metatarsal pads to offload the nerve, and anti-inflammatory medications. Custom orthotics can correct underlying foot mechanics that contribute to nerve compression.
Corticosteroid injections provide significant relief in many patients and can be repeated a limited number of times. MLS laser therapy and/or Shockwave Therapy are other available treatment options
If conservative care fails after several months, removal of the neuroma versus release (decompression) of structures around the neuroma are available surgical options. Recovery is typically 3–6 weeks.
