Ask the doctors: Morton’s neuroma causes sensation of pressure in the foot
Q: This weird thing keeps happening where it feels like the sock in my left shoe has gotten wadded up underneath the ball of my foot. Every time I check, nothing is wrong. Is something wrong? My health insurance isn't very good, so deciding to see a doctor is a big deal.
A: The dilemma in your letter — whether or not you can afford to see a doctor — is unfortunately not uncommon. For many people, the first response to a possible illness is the mental mathematics of how it will play out in their budget. But it's important to know that delaying a visit runs the risk that a small or manageable problem can escalate into something more serious. In the end, this can be even more expensive. We hope that the information we share here can help you in your final decision.
The sensation that you have described of a lump or mass beneath the ball of the foot sounds like a condition known as Morton's neuroma. People with this diagnosis often use the same image of a wrinkled or balled-up sock that you shared with us. It's caused by a pinched nerve in the foot, typically between the third and fourth toes. The pressure on the nerve causes it to send faulty data to the brain, including sensations of fullness, pressure and constriction. The brain then offers a logical interpretation: There's an object beneath your foot.
There are multiple causes of Morton's neuroma. Physical injury to the forefoot is one. It could be the effects of ill-fitting shoes, including those that are too tight, too loose or with heels that are too high. It can also be caused by biomechanical problems such as flat feet or high arches, which require specialized support for stability.
Conditions such as hammer toe and bunions are also considered risk factors for this condition. The repetitive impact that is a part of sports such as running, tennis and basketball can also give rise to a neuroma.
A reason to see a doctor is to rule out a stress fracture or a break. This would be done with an X-ray. The neuroma itself may be identified with a physical exam to locate the source of the tenderness or the presence of a mass. Some people find the condition improves with a change of footwear.
Flat-soled shoes with a padded insole and a roomy toe box prevent constriction. Custom shoe inserts, known as orthotics, can also offer relief. In some cases, medications to manage inflammation or pain may be prescribed. When the condition is severe, surgery may become an option.
If you have Morton's neuroma, your activities, the mechanics of your gait or your choice of footwear may unknowingly worsen the condition. For this reason, we urge you to see your doctor. They can assess the possible causes of the condition and offer a diagnosis. And if you share your financial concerns, most doctors will work with you on a solution that will address the problem and also protect your budget.
• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.
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