Morton's Neuroma

What happens in Morton's neuroma

Digital nerves run between the long bones of the forefoot (metatarsals) to supply the toes. Between the metatarsal heads, they pass under a ligament. Repeated compression and irritation, especially when shoes squeeze the forefoot, cause the tissue around the nerve to thicken (perineural fibrosis). Despite the name, it is not a true tumor. The thickened nerve is pinched further with each step, causing pain.

Symptoms

• burning, sharp or shooting pain in the ball of the foot, usually between the 3rd and 4th toes
• pain that spreads into the toes
• tingling, numbness or "electric" sensations in the two adjacent toes
• a feeling of standing on a pebble, marble or folded sock
• worse when walking, running or wearing tight or high-heeled shoes
• relieved by removing shoes and rubbing the foot
• usually one foot, occasionally both

There is no visible lump in most cases.

Causes and risk factors

• narrow, tight or pointed-toe shoes
• high heels, which push weight onto the forefoot
• high-impact sports: running, court sports
• tight-fitting sports shoes: ski boots, climbing shoes
• foot shape: bunions, hammer toes, flat feet, high arches
• female sex: women are affected far more often, partly due to footwear
• age: most common between 40 and 60

Conditions that cause similar pain

Diagnosis

A doctor or podiatrist diagnoses Morton's neuroma mainly by examination:

• squeezing the space between the metatarsal heads reproduces the pain
• Mulder's click: squeezing the forefoot while pressing between the bones produces a palpable click and pain
• checking toe sensation

Imaging helps confirm the diagnosis or rule out other problems:

• ultrasound shows the thickened nerve and is often used to guide injections
• MRI in uncertain cases
• X-ray to exclude stress fractures and arthritis

Treatment

Footwear and padding

• wear shoes with a wide toe box, low heels and cushioned soles
• metatarsal pads placed just behind the painful area spread the bones and take pressure off the nerve
• custom or over-the-counter orthotics for flat feet or high arches
• reduce high-impact activity temporarily
• ice and over-the-counter pain relief (acetaminophen or ibuprofen, following the label dose)

These steps help many people, especially if started early.

Injections

• Corticosteroid injection, often ultrasound-guided, reduces inflammation and gives relief for weeks to months. Repeated injections are limited because they can thin the fat pad of the foot.
• Alcohol sclerosing injections and radiofrequency ablation or cryoablation are used in some centers, with mixed evidence.

Surgery

If symptoms persist for 6 to 12 months despite conservative care:

• Neurectomy: removing the affected section of nerve. It relieves pain in most people but leaves permanent numbness between the two toes. A painful stump neuroma can form in a minority.
• Decompression: releasing the ligament over the nerve to relieve pressure, preserving the nerve.

Recovery takes several weeks, with a surgical shoe at first.

Prevention

• avoid tight, pointed or high-heeled shoes for long periods
• choose running and sports shoes with enough width
• replace worn-out athletic shoes
• use orthotics if your foot shape puts pressure on the forefoot

Frequently asked questions

What does Morton's neuroma feel like?

It typically feels like a burning or sharp pain in the ball of the foot, often between the third and fourth toes, with tingling or numbness in those toes. Many people describe it as standing on a pebble or a folded sock.

What causes Morton's neuroma?

It develops when a nerve between the toe bones is repeatedly compressed and irritated, usually by tight, narrow or high-heeled shoes. High-impact sports and foot shapes such as bunions, flat feet or high arches increase the risk.

Can Morton's neuroma go away on its own?

Symptoms often improve, sometimes completely, with wider shoes, metatarsal pads and reduced pressure on the forefoot. The thickened tissue itself may not disappear, but it can stop causing pain once it is no longer compressed.

What is the best treatment for Morton's neuroma?

Start with wide, low-heeled shoes, metatarsal pads and orthotics. If pain persists, an ultrasound-guided steroid injection often helps. Surgery to remove or decompress the nerve is reserved for cases that do not improve after several months.

Is Morton's neuroma serious?

It is not dangerous and is not cancer, but it can be very painful and limit walking and exercise. Most people improve with simple measures. See a doctor if pain persists, worsens, or you have diabetes.