Health guide · Podiatry
Morton’s neuroma: symptoms, causes, relief and treatment options
That feeling of walking on a pebble explained: what Morton’s neuroma is, how it’s diagnosed, what helps at home and when injections or surgery make sense.
The short answer
Morton’s neuroma is a thickened, irritated nerve between two toes, most often the third and fourth. It causes burning or sharp pain in the ball of the foot, a feeling of standing on a pebble or a folded sock, and sometimes tingling or numbness in the toes. It isn’t a tumor and isn’t dangerous.
Most people improve by taking pressure off the nerve: wide, low-heeled shoes with a roomy toe box and a metatarsal pad placed just behind the ball of the foot. A steroid injection can help if that isn’t enough, and surgery is an option when pain lasts for months despite treatment.
Want it checked? Find an Evolve Health podiatrist near you
This guide is for general information and is not a diagnosis. Some services may not be offered at every office; your provider will go over your treatment options at your appointment.
What is Morton’s neuroma?
Morton’s neuroma, also called an interdigital neuroma, is a thickening of the tissue around one of the small nerves that run between the toe bones to the toes. The nerve gets squeezed and rubbed where it passes between the long bones of the foot (the metatarsals), and over time the tissue around it becomes thick and irritated.
It most often develops between the third and fourth toes, and sometimes between the second and third. It usually affects one foot. It’s more common in women, probably because of narrow shoes and heels, and in people in their 40s to 60s.
Despite the name, a neuroma here isn’t a tumor and can’t turn into cancer. It’s a pinched, irritated nerve.
Morton’s neuroma symptoms
The symptoms usually come on gradually and are often worse in certain shoes.
- burning or sharp pain in the ball of the foot, usually between two toes
- a feeling of standing on a pebble or marble, or of a sock bunched up under your toes
- pain that shoots into the two toes on either side of the nerve
- tingling or numbness in those toes
- pain that’s worse in tight shoes, heels, or after walking or running
- relief when you take your shoes off and rub the ball of your foot
At first you may notice it only in certain shoes or after a long day. Without changes, the pain can become more frequent and harder to shake. Visible swelling is unusual, and pain that wakes you at night or affects both feet points more to other nerve problems.
Morton’s neuroma or something else?
Several problems cause pain in the same area. A podiatrist can tell them apart:
| Condition | How it usually differs |
|---|---|
| Metatarsalgia | An aching, bruised feeling under the ball of the foot, with the joints tender to press, and usually no tingling in the toes |
| Irritated or torn ligament under a toe joint (capsulitis or a plantar plate tear) | Pain under the joint at the base of one toe, most often the second, and the toe may start to drift or lift |
| Stress fracture | Pain on the top of the foot that builds with activity, one spot on the bone that hurts to press, and often swelling |
| Tarsal tunnel syndrome or neuropathy | Burning, tingling or numbness across the whole sole or in both feet, often worse at night |
| Arthritis in a toe joint | Stiffness and swelling at the joint itself |
Our guides to ball-of-foot pain (metatarsalgia), nerve pain in the feet and sharp pain in the foot cover these in more detail.
What causes Morton’s neuroma?
The exact cause isn’t fully understood, but repeated pressure on the nerve between the toe bones is the main factor. These things make it more likely:
- Shoes: tight, narrow or pointed shoes that squeeze the toes together, and high heels that push your weight onto the ball of the foot.
- Foot shape: bunions, hammertoes, flat feet or high arches, which change how pressure spreads across the forefoot.
- Activities: running, court sports, and anything with lots of pushing off or time on the balls of your feet, such as dance.
- Tight sports footwear: ski boots, climbing shoes and snug athletic shoes that press on the forefoot for hours.
How Morton’s neuroma is diagnosed
Most of the time, a podiatrist can diagnose Morton’s neuroma from your symptoms and an exam. They’ll ask when the pain started and what makes it better or worse, look at your shoes, and press on different parts of your foot.
- Web space squeeze: pressing between the toe bones on the sole reproduces your pain.
- Mulder’s click: squeezing the sides of the forefoot while pressing on the painful spot can produce a click you feel, along with your usual pain.
An X-ray doesn’t show the nerve, but it rules out a stress fracture, arthritis or a bone problem. Evolve Health podiatrists have digital X-ray on site. If the diagnosis is still unclear, or before surgery, an ultrasound or MRI can show the thickened nerve. Scans sometimes show a neuroma in people with no pain at all, so they’re used to back up the exam rather than replace it.
Treatment to try first
Non-surgical treatment is always the first step, and it helps many people. The aim is to take pressure off the nerve so the irritation can settle. Give it time: improvement often takes several weeks, and it’s common to try these steps for about 3 months before moving on.
Change your shoes
This is the most important step.
- Choose a wide, deep toe box so your toes can spread.
- Keep heels low. The higher the heel, the more of your weight lands on the ball of the foot.
- Look for a cushioned sole. A slightly stiff or rocker-bottom sole takes load off the ball of the foot.
- Loosen the laces across the front of the foot if they press.
- Save narrow or high-heeled shoes for short periods, or skip them until the pain settles.
Use a metatarsal pad or orthotic
A metatarsal pad is a small dome that sits just behind the ball of your foot, not under the painful spot. It lifts and spreads the toe bones slightly so the nerve is squeezed less. If a pad makes the pain worse, it’s probably too far forward or too thick.
Store-bought pads and inserts are a good start. A custom orthotic can build in a pad and address flat feet or high arches that add to the pressure. See our guide to whether you need orthotics and custom orthotics at Evolve Health.
Rest, ice and pain relief
- Ease off running, jumping and long periods of standing while the pain is bad. Swimming and cycling keep you fit with less pressure on the forefoot.
- Ice the ball of the foot for 15 to 20 minutes after activity, with a cloth between the ice and your skin. Skip ice if your feet are numb from diabetes or neuropathy.
- Massage the ball of the foot gently when you take your shoes off.
- An over-the-counter anti-inflammatory, such as ibuprofen or naproxen, can ease flares if it’s safe for you. Check with your doctor first if you have kidney disease, heart disease or stomach ulcers, or take a blood thinner.
A physical therapist can help with calf stretching, foot strengthening and the way you walk or run, which can take some load off the forefoot. See our therapeutic exercise programs.
Injections for Morton’s neuroma
Steroid injections
If shoes and padding aren’t enough, a steroid (cortisone) injection into the space between the toe bones can calm the irritated tissue. It’s done in the office, often with a numbing medicine mixed in. Many people get relief for weeks to months, and in a clinical trial, steroid injections worked better than numbing injections alone at 3 months. The effect doesn’t always last.
Podiatrists usually limit the number of steroid injections, because repeated shots can thin the protective fat pad under the ball of the foot, lighten or thin the skin, and weaken the tissue that holds the toes straight.
Alcohol (sclerosing) injections
Some specialists inject a dilute alcohol solution around the nerve, usually as a series of several injections, to make it less sensitive. Early reports were encouraging, but longer-term studies found that relief often didn’t last and many people went on to have surgery. Ask about the evidence and the number of visits before you start.
Other treatments: what the evidence says
You may see these offered for Morton’s neuroma:
- Radiofrequency ablation, which uses heat through a needle to quiet the nerve.
- Cryoablation, which uses extreme cold through a needle.
- Shockwave therapy, which uses sound waves applied through the skin.
Each has been tested only in small studies. Some people get relief, but they aren’t yet standard treatment, results vary, and insurance may not cover them. They’re options to discuss with your podiatrist after shoes, padding and injections, not a replacement for them.
Morton’s neuroma surgery
Surgery is considered when pain still limits your daily life after about 3 to 6 months of good non-surgical treatment. It’s usually done as outpatient surgery, so you go home the same day.
Types of surgery
- Removing the nerve (neurectomy): the surgeon removes the thickened section of nerve, usually through a cut on the top of the foot so the scar isn’t on the part you walk on. It’s the most common operation. A cut on the sole is sometimes used, especially if a neuroma comes back, but that scar can be tender.
- Releasing the nerve (decompression): the surgeon cuts the ligament that runs across the top of the nerve, giving it more room, and leaves the nerve in place.
Results and risks
Most people who have a neuroma removed get good pain relief, although some still have some discomfort. Things to know before you decide:
- Numbness between the two toes is expected after the nerve is removed and is usually permanent. Most people find it much easier to live with than the pain.
- A stump neuroma can form in a small number of people, when the cut end of the nerve grows into a painful knot. It may need more treatment.
- Other risks include infection, slow wound healing, a tender scar, and swelling that takes months to settle.
Recovery after Morton’s neuroma surgery
Recovery depends on the type of surgery and where the cut was made. This is a typical pattern after surgery through the top of the foot:
| Time after surgery | What to expect |
|---|---|
| First 2 weeks | Walking short distances in a post-surgery shoe, keeping the foot raised and the dressing dry. Stitches usually come out at about 2 weeks. |
| Weeks 2 to 4 | Moving into soft, roomy shoes as the swelling allows, and walking a little more each day. |
| Weeks 4 to 6 | Most people are back to normal daily activities in supportive shoes. |
| 6 to 12 weeks | A gradual return to running and sport. Some swelling can last a few months. |
A cut on the sole of the foot usually means a longer time with less weight on the foot. Always follow your own surgeon’s instructions. Sticking with roomy shoes afterward helps protect the other spaces between your toes, and your other foot.
When to see a podiatrist
Book a visit if:
- ball-of-foot pain, burning or tingling lasts more than 2 to 3 weeks after changing your shoes
- the pain keeps coming back, or you’re changing the way you walk to avoid it
- your toes are numb, or the pain is spreading
- you’re not sure what’s causing it
Get seen the same day if your foot is red, hot and swollen or you have a fever, or you can’t put weight on it after an injury.
If you have diabetes or neuropathy, numb or tingling toes may be nerve damage rather than a neuroma. Don’t use ice or heat on numb feet, and have any new symptoms checked.
Morton’s neuroma is easiest to treat early, before the nerve has been irritated for a long time. You can find a podiatrist near you and book online.
Questions, answered
Most people describe burning or sharp pain in the ball of the foot, often between the third and fourth toes, and a feeling of standing on a pebble, a marble or a fold in the sock. The pain can shoot into the toes, and the toes may tingle or go numb. It’s usually worse in tight shoes or heels and better when you take your shoes off and rub your foot.
The nerve between two toe bones gets squeezed and rubbed over and over, and the tissue around it thickens. Tight, narrow shoes and high heels are the most common triggers. Bunions, hammertoes, flat feet or high arches, and running or court sports that load the ball of the foot also raise the risk. It’s more common in women and in middle age.
The thickened nerve itself doesn’t usually disappear, but the pain often settles once the pressure on it is taken away. Many people get good relief from wider shoes, a metatarsal pad and less high-impact activity, and never need more treatment. If you keep wearing the shoes that triggered it, it tends to come back.
Choose shoes with a wide, deep toe box so your toes aren’t squeezed, a low heel, and a cushioned sole. A slightly stiff or rocker-bottom sole takes more load off the ball of the foot. Avoid narrow, pointed shoes and high heels, and make sure there’s room for a metatarsal pad or orthotic if you use one.
The pad goes just behind the ball of the foot, not under the painful spot. Its job is to lift and spread the toe bones slightly so the nerve between them is squeezed less. If it makes the pain worse, it’s probably too far forward or too thick, and a podiatrist can place it for you.
They often help. A steroid injection can calm the irritated tissue and ease pain for weeks to months, and it works best alongside better shoes and padding. The relief doesn’t always last, and podiatrists usually limit the number of injections, because repeated steroid shots can thin the fat pad under the foot and weaken tissue around the toes.
Usually yes, with some changes. Swimming, cycling and elliptical workouts put less pressure on the ball of the foot than running or jumping. If you run, cushioned shoes with a roomy toe box and a metatarsal pad can help, and you may need to cut back for a while if pain flares.
Surgery is considered when pain still limits your daily life after about 3 to 6 months of good non-surgical treatment, such as proper shoes, padding and injections. The usual operation removes the thickened part of the nerve, which leaves a small area of permanent numbness between the toes. Another option frees the nerve by releasing the ligament above it.
Most people walk in a post-surgery shoe from the start, have stitches out after about 2 weeks, and are back in roomy regular shoes around 3 to 4 weeks. Running and sport usually wait until about 6 to 12 weeks, and some swelling can last a few months. Your surgeon’s instructions come first.
It isn’t dangerous and isn’t cancer, even though the word neuroma sounds alarming. But it can be very painful and can make walking and shoes uncomfortable, and it tends to get worse if the pressure on the nerve continues. That’s why it’s worth treating early.
This guide is for general education and doesn’t replace advice from your own doctor. Everyone’s situation is different, so talk to a healthcare provider about symptoms that are new, getting worse or worrying you. If you think you may have a medical emergency, call 911. Reading this guide doesn’t make you a patient of Evolve Health.
Want a specialist to take a look?
A guide can explain, but it can’t examine you. Evolve Health providers see patients across Florida and Texas, and you can book online any time.
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