What it is

Morton’s neuroma is a thickening and irritation of a digital nerve between the metatarsal heads, most often between the third and fourth toes. It causes burning forefoot pain and a feeling of a pebble under the ball of the foot. There may be tingling or numbness spreading into these toes.

The exact cause of Morton neuroma is not known, but it's likely related to pressure on the nerve. Symptoms worsen with narrow shoes and long standing. Spreading the metatarsals and reducing pressure helps. Morton neuroma also is called interdigital neuroma.

What happens when it occurs

Repetitive compression irritates the nerve and surrounding tissue. Reducing pressure and improving foot mechanics calm the nerve. Persistent cases may need injections or surgery.

Common causes and risk factors

  • Narrow toe boxes and high heels
  • Forefoot overload from gait mechanics or calf tightness
  • High impact or court sports on hard surfaces
  • Foot deformities such as bunions, hammertoes, high arches or flat feet.

Who is most affected

Adults in their middle years. Women present more often than men in clinics.

Typical symptoms

  • Burning or electric pain in the forefoot with a pebble sensation
  • Stabbing, shooting or burning pain in the ball of the foot
  • Numbness in the adjacent toes
  • Pain with tight shoes and relief when shoes are removed
  • Pain when stretching toes
  • Clicking sensation in the forefoot

When to seek care

If forefoot pain persists, disturbs walking or running, or if numbness spreads, especially if you experience a burning pain in the ball of your foot that's not improving with a change in footwear or activities that put a strain on your feet.

How we diagnose

History and squeeze tests that reproduce symptoms. Ultrasound confirms the neuroma and guides injections when needed.

Management

  • Footwear with a wide toe box and soft upper, avoid narrow heels
  • Metatarsal dome or padding to spread pressure
  • Calf and intrinsic foot strength, gait coaching
  • Ultrasound guided injections for persistent pain

If your symptoms do not improve, or if they come back after nonsurgical treatment, your surgeon may recommend surgery to either:

  • Remove the diseased portion of the nerve, or
  • Release tissue around the nerve
  • Surgery is often considered to be the most reliable form of treatment for a Morton's neuroma, with many studies showing an 80 to 95% success rate.

Outcomes

  • Conservative measures, such as changes in footwear, activity modification, and the addition of orthoses, may provide some degree of relief for up to 50% of patients.
  • Corticosteroid injections seem to provide successful relief from Morton’s neuroma about 50% of the time.
  • Chemical nerve ablation and radiofrequency ablation also have a good success rate, with 70 to 80% of patients noting improvement after these interventions.
  • Surgical intervention with neurectomy (removal of part of the nerve) or decompression of the nerve has the highest success rate, with most studies reporting an 80 to 95% success rate.

Even after successful surgical treatment, it is possible for Morton’s neuroma to come back. Approximately 5 to 20% of patients may have symptoms return and need additional treatment. Fortunately, a repeat surgery for Morton's neuroma recurrence has a similar success rate to the initial surgery (80 to 95%).

Rehabilitation milestones

Phase 1 weeks 0 to 2: footwear and padding changes, pain control.

Phase 2 weeks 2 to 6: strength and balance, walking goals.

Phase 3 weeks 6 to 12: graded return to running or court sport.

Phase 4 months 3 to 6: performance and workload tolerance; post op milestones when relevant.

The recovery period after surgery for Morton's neuroma is short. Protocols differ, and you should follow the specific instructions of your operating surgeon.

In general, you will be allowed to walk on your foot in a stiff-soled shoe, also known as a post-op shoe, though you may be asked to put all your weight on your heel if an incision was made on the bottom of your foot.

You should avoid heavier activities (running, jumping, etc.) and putting your foot underwater (such as in a bathtub or swimming pool) until your surgical wounds are completely healed — usually until at least 2 to 3 weeks after surgery.

Patients are commonly allowed to return to normal shoe wear by 4 weeks after the procedure.

Readiness to progress

  • Comfortable walking distance in suitable shoes
  • Strength and balance within targets
  • Running drills without next day symptoms

Long term care

  • Choose roomier shoes for longer days
  • Use padding on high load days
  • Keep calf and intrinsic strength high

Australia snapshot

  • Common forefoot complaint in adult clinics
  • Women present more often than men in presentation data
  • Day surgery pathways are widely available when needed

Latest insights

Space the forefoot, calm the nerve, and build strength. Many settle without surgery.

Injection or surgery is reserved for persistent pain that limits life.

Frequently Asked Questions

Persistent irritation is uncomfortable but unlikely to cause widespread nerve damage. Early load changes help.

Often a metatarsal dome and wider shoes are enough. Orthotics are used when mechanics need more support.

Ultrasound guided injections are common and can reduce pain. They do not change mechanics, so continue strength and footwear work.

Yes in roomier shoes on forgiving surfaces once pain settles. Build distance gradually.

Wide toe box, soft upper, and a stable midsole. Avoid narrow heels for long days.

Many improve within weeks once pressure is reduced and strength increases.

Night pain, progressive numbness, or swelling need review.