March 04, 2026 | Nerve Pain
4 minute read
Have you ever heard the term ‘Morton’s Neuroma’? This medical condition was first described in 1876 by surgeon TG Morton in Philadelphia. It typically refers to a tender spot at the balls of the foot or between the toes that can cause pain and sometimes numbness in the space between the involved digits. Once diagnosed, many clinicians will operate on the nerve, cut it, and allow it to retract into the muscles between the toes. However, is the term ‘neuroma’ really correct? And if not, is this surgical treatment the best way forward?
Let’s start with the term ‘neuroma’ which historically has a somewhat murky definition. Historically a neuroma was defined as a histologic entity – meaning characteristics seen under a microscope after a nerve biopsy. Based on this definition, the two hallmark features of a neuroma are disorganized, regenerating nerve fibers and the presence of scar tissue. Most commonly, these phenomena occur in response to disruption of a nerve that can occur with injuries such as a lacerations, severe crush injuries or even prior surgery. However, in the past clinicians have also used the term neuroma to mean any swelling of a nerve such as would be seen with a nerve tumor (e.g., a schwannoma or acoustic neuroma). More recently, doctors have begun to distinguish between the first group – now generally considered ‘true neuromas’ because they contain all the elements of the nerve sheath and the latter group, now more accurately referred to as ‘false neuromas’.
So is a Morton’s neuroma a true or false neuroma and what difference does this distinction make? In my opinion, Morton’s neuromas are false neuromas and this distinction makes a lot of difference. False neuromas seem to represent areas of nerve swelling or abnormal growth. If it is a benign tumor such as a schwannoma or acoustic neuroma, the abnormal growth must be removed, and the nerve is left intact. Similarly, these ‘false neuromas’ can also occur when the nerve is pinched or compressed. Think about what happens when you tie a tight rubber band to the base of your finger and after a few minutes, that finger becomes swollen and purple. The reason these distinctions matter is that false neuromas do not need to be treated by cutting the nerves. In doing so, a true neuroma can form, one that is potentially much more difficult to treat and can cause even more discomfort. In my experience, many patients who have presented to my office with a diagnosis of Morton’s neuroma simply have a nerve compression issue that happens to occur between the toes.
You can see in the first illustration below that as the common digital nerve passes in between the metatarsal heads (i.e., the balls of the feet) there is a very tight deep metatarsal ligament that is compressing the nerve as it heads distally towards the toes and splits into the proper digital nerves going to either side of the webspace. The second picture – from the operating room – shows the nearly the exact same pathology with the compressive ligament (green arrow) and nerve barely visible (orange arrow). Once released (last picture), much more of the nerve can be identified (between the blue loops) and less swelling of the nerve is noted just as would be seen by release of a tight rubber band at the base of the finger. The remaining crossing structure is the blood vessel to the toes, is soft, non-compressive, and must be preserved. Therefore, this nerve will not need to be cut and the risk of it retracting and forming a ‘true neuroma’ more deeply within the foot is significantly minimized. In addition, because the nerve is left intact, sensation between the toes is maintained.
It is therefore important to have a discussion with your treating peripheral nerve surgeon to come up with an appropriate surgical plan. Not every case is the same and some situations may still require nerve transection. But many patients diagnosed with Morton’s ‘neuroma’ are actually suffering from a nerve compression problem. Understanding what’s actually happening inside your foot helps you make a more informed decision — and may help preserve both comfort and sensation.
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