Neuroma

A Morton's neuroma is a thickening of the tissue around one of the digital nerves that runs between the metatarsal bones to the toes. It most commonly affects the nerve between the third and fourth toes, though the space between the second and third toes can also be involved.

Despite the name, a neuroma is not a tumor — it is a benign enlargement and fibrosis of the nerve sheath caused by chronic compression and irritation. The nerve tissue responds to repeated pressure by thickening, which in turn makes it more susceptible to the same compression that caused the problem — a self-reinforcing cycle that explains why neuroma symptoms tend to worsen progressively without treatment.

The characteristic symptoms are highly recognizable: a burning, stinging, or shooting pain in the ball of the foot that radiates into the third and fourth toes; numbness or tingling in the affected toes; and a sensation often described as walking on a pebble, a marble, or a bunched-up sock — something that isn't there but feels very real with every step. Symptoms are typically worsened by narrow or pointed footwear and by prolonged standing, and relieved by removing the shoe and rubbing the forefoot.

Left untreated, neuromas tend to enlarge and become progressively more symptomatic. Early intervention — when the nerve tissue has not yet undergone significant fibrotic change — produces better outcomes with conservative treatment and a lower likelihood of requiring more invasive management.

Dr. Gunter diagnoses neuromas clinically, with ultrasound evaluation when appropriate, and develops a treatment plan scaled to the severity of the presentation.