Morton’s Neuroma (Nerve pain 4th toe area)
A neuroma is a thickening of nerve tissue which, when it affects the foot, most commonly occurs between the third and fourth toes although it can occur in other parts of the foot. The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to tingling, burning, or numbness and pain. Some describe a feeling that something is inside the ball of the foot or that there’s something in the shoe or a sock is bunched up. Ultimately, if gone unchecked, nerve damage can occur in the guise of numbness in the fourth toe. It is caused by a combination of flexible feet and tight or high heeled shoes. People who are predisposed to this annoying problem usually have very flexible feet where the metatarsal bones are mobile or unstable at the propulsive stage of gait. Instead of just callousing like in metatarsalgia, the nerve is getting pinched between the two metatarsal bones as they move, causing inflammation and swelling, which only exasperates the problem by making the nerve thicker.
$ Self-Help
Wear shoes that are not so tight across the ball of the foot. Pumps and ballet flats are not recommended because they must be slightly tight at the ball to stay on the heel and have very thin flexible soles. For women’s dress shoes, switching to a Maryjane style to hold it on will allow for wearing a wider or longer size.
$ Shoe Repair Store or Pedorthist
Shoe stretching can help with shoes that are too tight.
$$ Athletic or Sporting Goods Store
Ready-made orthotic devices with a significant metatarsal elevation can also be helpful.
$$$ Pedorthist
Custom orthotic devices from a certified pedorthist will stabilize the metatarsal bones and reduce the irritation, especially if a significant metatarsal pad is incorporated to elevate the fourth metatarsal and thereby increase the spacing between the bones. A pedorthist can also counsel you on proper footwear and integrate the devices with the footwear.
$$$$ Podiatrist or Orthopedic Surgeon
If non-invasive treatments don’t quite cut it, a cortisone injection my help, and in a worse case scenario, surgery can remove the affected nerve with the result being a numb 4th toe.