Tingling and burning pain between the toes are commonly diagnosed as Morton's neuroma in modern medicine. This condition occurs when the nerves passing between the toes become thickened or inflamed due to sustained compression and irritation. It develops most often between the third and fourth toes, or between the second and third toes, with many people describing the sensation as feeling like a pebble lodged under the toes or walking on sand.
The primary cause of interdigital neuroma is mechanical pressure. Pointed shoes and high heels compress the forefoot and shift body weight forward, placing excessive strain on the plantar nerve. In addition, footwear that squeezes the toes together, such as narrow shoes, completely flat shoes, or soccer cleats, can also contribute. Structural foot variations such as flatfoot or pes cavus, along with repetitive impact from activities like running or jumping, can cause chronic nerve irritation.
Pathophysiologically, repetitive compression and friction reduce the local blood supply and induce an inflammatory response. In early stages, edema and inflammation appear around the nerve. When irritation becomes chronic, the surrounding fibrous tissue proliferates to form a mass known as a neuroma. This mass compresses the nerve further and releases inflammatory mediators, perpetuating a cycle that aggravates pain. The pain typically worsens while walking or standing, and temporarily improves when removing shoes and resting.
Diagnosis relies mainly on a physical examination by a foot specialist. The practitioner palpates the sole to identify tender points and checks for the Mulder sign, where a characteristic click is felt or heard when compressing the metatarsal heads together. Imaging studies such as ultrasound or magnetic resonance imaging help confirm the size and location of the neuroma while ruling out conditions such as stress fractures or tumors. What the Donguibogam describes as qi stagnation and blood stasis aligns with nerve injury, inflammation, and circulatory disorders caused by external pressure. Even mild foot pain should not be ignored, and receiving an accurate professional assessment is recommended to prevent chronic pain or progressive nerve injury.
