The nerves that supply the sensation to the smaller toes originate on the bottom of the foot. They travel between the bones of the foot and at the head of the metatarsal the nerve will divide into 2 nerves, one going to the adjacent 2 toes. A ligament crosses between and attached to the metatarsal heads and perpendicular to the nerve. When there is an over use injury or injury to the nerve, the nerve can become swollen. This will lead to patients describing numbness, burning, tingling or shooting pains in the toes. There can be a feeling of walking on a pebble or a rock on the ball of the foot. This then causes pain and discomfort. A Morton’s neuroma is classically described and most often affects the nerve that supplies sensation to the 3rd and 4th toes. Yet, it can occur at the nerve between any of the toes.
Xrays, ultrasound, MRI and NCV can be used to make the diagnosis as well. Conservative therapy includes: orthotics, padding, injection (cortisone), shoe modification. Theses measure should be tried first before having surgery.
If surgery is needed there are several of options. Most surgeries have a fast recovery period. The most non invasive procedure is a Neuolysis (to free the nerve), this requires a small incision and cutting the ligament that is putting pressure on the nerve. There are other surgeries which include basically killing the nerve, this can be done by cryotherapy (freezing nerve) or excision of nerve (cutting the nerve).