A common cause of forefoot pain is a thickened, irritated nerve called a Morton's neuroma. It is characteristically associated with pain in the ball of the foot and shooting pains into the toes and often burning or tingling in the affected toes.
What it is not?
It is not a tumour, and it does not require any treatment if it is not causing significant symptoms.
How is it treated?
Simple treatments are often effective. A wider and deeper toe-box shoe will often lead to improvement in symptoms. Lower heels may also help. A metatarsal dome or bar can also be very useful. If these simple treatments fail to improve symptoms you may consider having a local anaesthetic and corticosteroid injection to reduce inflammation of the tissues around the nerve. In many cases this will be all that is required.
What if the symptoms recur?
If the injection had a temporary effect but the symptoms have returned, the options are percutaneous nerve ablation or surgery. Percutaneous or needle-based ablation using ethanol or a radio-frequency (heated) probe is performed by interventional radiologists using ultrasound to guide the needle to the neuroma.
What does surgery involve?
Surgery is an option if the symptoms are bad enough and conservative treatments have failed to provide lasting relief. The surgical procedure is called an interdigital neurectomy and it literally means taking out the nerve between two adjacent toes. This will result in improvement in symptoms in most patients. It will result in numbness in half of each involved toe. It is performed as a day procedure under general anaesthesia in most patients. It is performed through an incision on top of the foot between the two involved toes. The procedure is reasonably quick (~10 minutes), however recovery from the surgery (swelling and discomfort) can take several weeks and full recovery may be a few months.