Morton's neuroma is a thickening of a nerve between the toes, usually between the third and fourth, causing burning, tingling or a sensation of standing on a pebble. It is not a tumour and is highly treatable. Most people improve with footwear changes and ultrasound-guided injections; surgery helps resistant cases.
Symptoms
- Burning, electric or tingling pain in the ball of the foot spreading into the toes
- A pebble-in-the-shoe feeling
- Sometimes numbness in adjacent toes
- Worse in narrow or high-heeled shoes; eases when the shoe is off and the foot is rubbed
Causes & risk factors
- Chronic compression of the nerve by the metatarsal heads
- A narrow toe box or raised heel
- More common in women 40–60
- Runners with high forefoot loading
Conservative treatment comes first
- Footwear changes — a wide toe box, heel under 4 cm, forefoot cushioning (50–60% improve)
- A metatarsal dome pad, correctly positioned
- An ultrasound-guided corticosteroid injection (60–70% relief from 1–3 injections)
- Alcohol sclerotherapy for relapse
- A same-day ultrasound at assessment confirms the diagnosis and measures the neuroma
When surgery is considered
Excision removes the neuroma and affected nerve, giving reliable lasting relief at the cost of a permanent numb patch in the web space — walking in a wide shoe within days, sport at 6–8 weeks. Decompression releases the ligament and preserves the nerve, avoiding numbness, but is less reliable for an established neuroma.
Questions & answers
Yes. Many early cases improve with footwear changes and reducing forefoot load, and most people avoid surgery altogether.
No. Metatarsalgia is overload under the metatarsal heads; Morton's neuroma is nerve compression with a distinct burning, electric quality.
Usually two to three steroid injections, after which alcohol sclerotherapy or surgery is considered.
Sources & further reading
- NHS — Morton's neuroma
- OrthoInfo (AAOS) — Morton's Neuroma
