Wear and tear on your feet can cause nerves to become thickened and irritated, a condition known as a neuroma. When this occurs in the nerve between the third and fourth toes, it’s called Morton’s neuroma.
The irritated nerve can produce sensations like those you feel from a bunched-up sock or some other object in your shoe, or in other cases, you may feel numbness. Pain is also a common result of this neuroma. Even if you feel as though you’re standing on something, it’s a phantom sensation and there’s no accompanying bump or bulge.
Nerve irritation is usually at the root of the condition, whether it’s caused by pressure or injury to nerves that lead to your toes.
Certain types of footwear can contribute. For example, high heels transfer much of the load on your foot to the ball area, which may cause foot tissue to stiffen and in turn, irritate nerves. Poor-fitting shoes that are tight or narrow may also cause irritation.
High-impact athletics, such as running or jogging, may contribute to repetitive strain in the foot, and activities like rock climbing transfer more load to the toes, creating conditions for neuroma. Foot deformities, such as hammertoes or bunions, as well as high or flat arches, may also create nerve irritation.
A change in footwear may ease the pressure and relieve the symptoms, as may pads or cushions in your shoes. Over-the-counter or prescription orthotics can help spread your body weight over a larger area of the foot to relieve localized pressure.
In advanced cases, when the tissue surrounding the nerve can’t recover, there are additional treatments. Corticosteroid injections are often effective, as is another injection called sclerosing, which typically uses an anesthetic and a concentrated alcohol solution, with the goal of decreasing the nerve’s ability to send pain signals.
Decompression surgery moves or removes tissue, such as ligaments, around the affected nerve, providing more room and reducing irritation. A last resort treatment involves complete removal of the nerve to achieve pain relief, though, depending on the nerve, there may be areas of permanent numbness along that nerve’s pathway.