Morton's neuroma
A painful condition caused by thickening of the tissue around one of the nerves between the toes, most commonly between the third and fourth toes. It produces sharp, burning pain in the ball of the foot.
📊 Morton's neuroma affects approximately 30% of women at some point in their life, although many cases are asymptomatic. Women are affected around 8-10 times more often than men. The third interspace (between the third and fourth toes) is involved in around 80% of cases.
What is Morton's neuroma?
Morton's neuroma is not a true tumour or nerve growth, despite its name. It is a benign thickening of the tissue (perineural fibrosis) around the common plantar digital nerve in the ball of the foot. The nerve becomes compressed and irritated between the heads of adjacent metatarsal bones, leading to swelling and the formation of a fibrotic mass. The third interspace is most commonly affected because the nerve here is larger and more vulnerable to compression than the others.
The condition typically causes sharp, burning, or electric-shock-like pain in the ball of the foot, often radiating to the toes. Many patients describe a sensation of walking on a pebble or having a fold in their sock. Symptoms are classically brought on by tight or narrow footwear and relieved by removing the shoe and massaging the foot. Numbness or tingling in the affected toes is common.
Treatment is largely conservative and includes footwear modification, orthotics, and image-guided injection of either local anaesthetic with steroid or alcohol (sclerosing injection). When conservative measures fail, surgical excision of the neuroma is highly successful, although it does result in permanent numbness between the affected toes - a trade-off that most patients are happy to accept for relief of pain.
Common causes
- Tight, narrow, or high-heeled footwear (the most important factor)
- Repetitive forefoot loading - running, dancing, racquet sports
- Foot shape abnormalities - flat feet, high arches, bunions
- Occupations involving prolonged standing or walking
- Trauma to the forefoot
- Inflammatory conditions (less common)
Who is at risk? Female sex is the strongest risk factor (8-10 times more common), driven largely by footwear. Other risk factors include age 40-60 years, occupations involving prolonged standing or walking, high-impact sports, foot deformities such as flat feet or bunions, and high BMI.
Symptoms
Symptoms vary depending on the severity and duration of the condition. Common symptoms include:
- Sharp, burning, or shooting pain in the ball of the foot, between the third and fourth toes (or less commonly between the second and third)
- Sensation of "walking on a pebble" or having a small stone in the shoe
- Pain that radiates into the toes
- Numbness or tingling in the affected toes
- Symptoms aggravated by tight or narrow shoes and high heels, relieved by removing the shoe
- A clicking sensation (Mulder click) when squeezing the forefoot
- Intermittent symptoms with attacks lasting minutes to hours
When to seek help: See a foot specialist if you have persistent forefoot pain affecting walking, if symptoms are not relieved by changing to wide, low-heeled footwear over several weeks, or if numbness or pain interferes with daily activities or sleep.
How is it diagnosed?
Your foot and ankle specialist will take a detailed history and examine the foot. The following investigations may be arranged to confirm the diagnosis:
- Clinical examination - tenderness on squeezing the affected interspace, positive Mulder click (palpable click with side-to-side compression of the forefoot)
- Ultrasound - the first-line imaging, identifying neuromas greater than 5mm and excluding other causes of forefoot pain
- MRI - reserved for diagnostic uncertainty or when planning surgery
- Diagnostic injection of local anaesthetic - relief of pain confirms the diagnosis
Small neuromas (less than 5mm) on imaging may be incidental and not the cause of symptoms. The diagnosis is primarily clinical, supported by imaging. Other causes of forefoot pain - metatarsalgia, metatarsal stress fracture, MTP joint synovitis, and Freiberg disease - should be excluded.
Treatment pathway
Treatment is tailored to the severity of the condition, your age, activity level, and overall health. Most conditions are treated in a stepwise fashion, starting with the least invasive options.
Footwear modification
Wide-toed, low-heeled, well-cushioned shoes are essential. Avoiding high heels and narrow or pointed shoes can reduce symptoms substantially. Many patients experience significant improvement from this single change alone.
Metatarsal pads and orthotics
A metatarsal pad placed just behind the affected metatarsal heads spreads the metatarsals apart and offloads the nerve. Custom orthotics can be helpful, particularly in patients with associated foot deformities.
Image-guided corticosteroid injection
Ultrasound-guided injection of local anaesthetic and corticosteroid provides relief in around 50-70% of patients. The effect may be temporary, but injections can be repeated cautiously. Repeated injections risk fat pad atrophy.
Sclerosing alcohol injection
A series of image-guided injections of dilute alcohol denatures the nerve and provides relief in around 60-80% of patients. This may be considered as an alternative to surgery in patients keen to avoid an operation.
Surgical excision of the neuroma
For symptoms that persist despite at least 6 months of conservative treatment, surgical excision of the neuroma is highly successful. Performed via a small incision on the top or bottom of the foot, around 80-85% of patients have a good or excellent result. The trade-off is permanent numbness between the affected toes - which most patients accept readily for pain relief.
Nerve decompression (release of intermetatarsal ligament)
A joint-preserving alternative to excision in selected cases. The deep transverse intermetatarsal ligament is divided to decompress the nerve, without removing it. Recovery is faster but results are less predictable than excision.
Recovery
After surgical excision, you can typically weight-bear in a postoperative shoe immediately. The wound is healed by 2 weeks, and most patients return to comfortable shoes by 4-6 weeks. Return to running and high-impact activity is usually possible by 2-3 months. The numbness left after excision is permanent but rarely troublesome.
- Footwear changes - significant relief: 4-6 weeks
- Injection effect: days to months
- Recovery from excision surgery: 4-6 weeks
- Return to all activities post-surgery: 2-3 months
What results can I expect?
Outcomes are good with appropriate treatment. Around 30-50% of patients respond well to footwear changes and conservative measures alone. Of those requiring surgery, around 80-85% have a good or excellent outcome. Recurrence (stump neuroma) is the main long-term concern after surgery, occurring in around 5-10% of cases.
In numbers
When can I…?
Typical activity timelines for this condition. These are approximate and vary considerably between patients. Always follow the specific guidance given by your surgeon and physiotherapist.
| Activity | Typical timeline | Notes |
|---|---|---|
| Wear wide shoes | Anytime | Wide, low-heeled shoes with plenty of toe room relieve pressure on the nerve and often help substantially.[1] |
| Drive | No restriction | Neuroma does not affect fitness to drive. |
| Use metatarsal pads | Anytime | A pad placed just behind the painful area spreads the metatarsal heads and reduces nerve compression.[1] |
| Consider injection | If shoes/pads insufficient | A single ultrasound-guided corticosteroid injection often gives substantial and sometimes lasting relief.[1] |
| Drive after surgery | 2-3 weeks | When the wound has healed and you can perform an emergency stop. Inform your insurer.[3] |
| Return to sport | 6-8 weeks after surgery | Gradual return once forefoot swelling and tenderness settle. A small permanent numb patch between the toes is expected.[1] |
Is this normal?
Common concerns from patients with this condition or recovering from treatment, and whether they are expected or worth mentioning to your team.
Preparing for surgery?
Read our step-by-step guide: what to expect before, during, and after your procedure.
Related conditions
Your questions, answered
Plain-English answers to the things people most often ask, grounded in published guidance. Tap a question to open it.
About thisWhat exactly is a Morton’s neuroma?
It is a thickening of the tissue around a nerve between the toes, most often between the third and fourth toes. It causes burning pain, tingling or numbness and a feeling of a pebble or sock ruck under the ball of the foot.
Tight or high-heeled shoes typically make it worse.
Your choiceWhat helps first?
Wide, low-heeled shoes with a roomy toe box, a metatarsal pad or insole to spread the bones, and activity or footwear changes help many people.
Simple measures are always the starting point.
InjectionsDo steroid injections work?
A corticosteroid injection can relieve pain and sometimes lasts a long time. Results vary between people and it can be repeated in some cases.
It is a reasonable step before considering surgery.
Your choiceWhen is surgery needed, and does it work?
Removing the affected nerve (excision) is offered for persistent symptoms despite footwear changes and injections. It usually relieves the pain.
It does leave permanent numbness between the affected toes, and there is a small chance of recurrence or a tender stump.
Getting backWhat is recovery after excision like?
Most people walk in a supportive or special shoe for a couple of weeks and return to normal footwear over a few weeks.
The numbness in the toes is expected and usually well tolerated.
UrgentWhat should prompt a review?
New numbness with weakness, or symptoms spreading after an injury, should be assessed rather than assumed to be a neuroma.
Seek advice if you are unsure.
References & further reading
- 1.British Orthopaedic Foot & Ankle Society: Morton neuroma patient information
- 2.NHS: Morton’s neuroma
- 3.Royal College of Surgeons of England: Driving after surgery guidance
References are to UK clinical guidance and patient information from recognised organisations. This page is for general information and does not replace personalised advice from your own clinical team.