Morton's neuroma is a thickening of nerve tissue between the toes. It commonly affects the nerve that travels between the third and fourth toes.

See also: Foot pain

Morton's neuroma is more common in women than men.

The exact cause is unknown. However, some experts believe the following may play a role in the development of this condition:

• Abnormal positioning of toes
• Flat feet
• Forefoot problems, including bunions and hammer toes
• High foot arches
• Tight shoes and high heels

Symptoms of Morton's neuroma include:

• Tingling in the space between the third and fourth toes
• Toe cramping
• Sharp, shooting, or burning pains in the ball of your foot (and sometimes toes)
• Pain that increases when wearing shoes or pressing on the area
• Pain that gets worse over time

In rare cases, nerve pain occurs in the space between the second and third toes. This is not a common form of Morton's neuroma, but treatment is similar.

A foot x-ray may be done to rule out bone problems. MRI or high-resolution ultrasound can successfully diagnose Morton's neuroma.

Nerve testing (electromyography) cannot definitely diagnose Morton's neuroma, but may be used to rule out conditions that cause similar symptoms.

Your doctor may order blood tests to check for inflammation-related conditions, including certain forms of arthritis.

Nonsurgical treatment is tried first. Your doctor may recommend any of the following:

• Padding and taping the toe area
• Shoe inserts
• Changes to footwear (for example, shoes with wider toe boxes)
• Anti-inflammatory medicines taken by mouth or injected into the toe area
• Nerve blocking medicines injected into the toe area
• Other painkillers
• Physical therapy

Anti-inflammatories and painkillers are not recommended for long-term treatment.

In some cases, surgery may be needed to remove the thickened tissue. This can help relieve pain and improve foot function. Numbness after surgery is permanent, but should not be painful.

Nonsurgical treatment does not always improve symptoms. Surgery to remove the thickened tissue is successful in about 85% of cases.

Morton's neuroma can make walking difficult. Persons with this foot condition may also have trouble performing activities that put pressure on the foot, such as pressing the gas pedal of an automobile. It may hurt to wear certain types of shoes, such as high-heels.

Call your health care provider if you have persistent pain or tingling in your foot or toe area.

Avoid ill-fitting shoes. Wear shoes with a wide toe box.

El-Khoury GY, Bennett DL, Dalinka MK, et al. Expert Panel on Musculoskeletal Imaging. Chronic foot pain. Reston, VA: American College of Radiology; 2005.

Scardina RJ, Lee SM. Morton neuroma. In: Frontera, WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation.2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 85.

When discussing needle size we can look at two characteristics: length and diameter.

The length of the needle used can vary based upon the examiner's preference or how much tissue exists between the skin and the desired muscle for the doctor to examine. Most needles are usually around one and one half inches but the sizes tend to vary from 1-3 inches in length

The diameter of the needle is measured in gauges, with the larger the number of the gauge corresponding to a smaller diameter. Most needles used for EMGs range from 26 gauge to 30 gauge.

Most of the pain that occurs with any needle insertion is usually from the initial insertion of the needle through the skin. This reduced by the technique of the doctor, the gauge (or diameter) of the needle, and the shape of the tip of the needle.