The reason for the nerve thickening is not known. It may be due to exposure to pressure between the joint heads. It is mainly due to pressure across the forefoot that results in pain, for example, when putting weight in the shoe. Many people think that it feels like stepping on a pebble. A padded insole that raises the front arch of the foot and spreads the joint heads can reduce the discomfort and should be attempted first. In the case of lengthy discomfort, an operation may be appropriate. During the operation the nerve nodule is removed. Since it is a sensory nerve, the feeling between the two toes disappears after the operation. The nerve nodule is removed through an incision in the sole of the foot. Despite this, there is almost never discomfort from the scar afterwards. Placing weight on the foot is allowed immediately according to ability. Sick leave is about 3-4 weeks.
If the discomfort is between the 3rd and 4th toe, the results of the operation are usually excellent. Not quite as good results if the discomfort is located between the second and third toe. The diagnosis can sometimes be difficult to make but an MRI scan usually does not help. Of course, not all pain in the toes is due to nerve nodules and surgery on the nodule does not help these other conditions.