Morton’s neuroma is a painful condition affecting one of the small nerves in the forefoot, most commonly between the third and fourth toes. It can cause burning pain, tingling, numbness, or the sensation of walking on a pebble or small fold in the shoe.
Mr Edward Dawe is a Consultant Trauma and Orthopaedic Surgeon specialising exclusively in foot and ankle surgery. Morton’s neuroma is usually assessed clinically, and investigations may be arranged where needed to help confirm the diagnosis or exclude other causes of forefoot pain.
What is Morton’s neuroma?
Morton’s neuroma is irritation and thickening of a nerve in the forefoot. Although the term “neuroma” is commonly used, it is usually not a true tumour. Symptoms often develop gradually and may become more noticeable in tighter shoes, during prolonged standing, or with higher-impact activity.
Forefoot pain is not always Morton’s neuroma
Pain in the forefoot can arise from a number of different conditions, and not all pain in the ball of the foot is caused by a Morton’s neuroma. Bunions can alter pressure across the forefoot and may contribute to pain, deformity and shoe discomfort. Other causes of forefoot pain can include metatarsalgia, joint problems, lesser toe deformity, overload of the forefoot, stress injury and other nerve-related symptoms.
For that reason, diagnosis is based on the pattern of symptoms, examination findings and, where needed, imaging. Treatment depends on identifying the most likely source of symptoms rather than assuming all forefoot pain is due to a neuroma.
Symptoms of Morton’s neuroma
Symptoms can include:
- pain in the ball of the foot
- burning pain spreading into the toes
- tingling or numbness in the toes
- discomfort made worse by tighter footwear
- a sensation of walking on a pebble or folded sock
How is Morton’s neuroma diagnosed?
Diagnosis is usually based on the history and examination. The site of pain, any altered sensation in the toes, and the pattern of symptoms can all help identify a Morton’s neuroma.
X-rays may be used to assess the forefoot and exclude other causes of pain. Ultrasound or MRI can sometimes be helpful where the diagnosis is unclear or where treatment planning requires further information.
Non-surgical treatment for Morton’s neuroma
Non-surgical treatment is often tried first. This may include changes in footwear, avoiding tight or narrow shoes, activity modification, and orthotic or insole support where appropriate.
In selected cases, an injection may be considered. This may help reduce symptoms and can sometimes also help confirm the source of pain. The suitability of injection treatment depends on the clinical findings and the location of symptoms.
When might surgery be considered?
Surgery may be considered when symptoms remain troublesome despite appropriate non-surgical treatment. The decision depends on the severity of symptoms, how much they affect day-to-day activity, and whether the diagnosis is sufficiently clear.
If surgery is being considered, the likely benefits, risks, recovery, and alternatives should be discussed in detail as part of treatment planning.
Frequently asked questions
Morton’s neuroma often causes burning pain in the forefoot, tingling or numbness in the toes, or the feeling of walking on a pebble or folded sock.
Yes. Forefoot pain can have several causes. Bunions, metatarsalgia, joint problems, lesser toe deformity, stress injury and other conditions can also cause pain in the front of the foot.
Yes. Some patients improve with wider footwear, activity modification, insoles or orthotics, and in selected cases injection treatment.
Not always. Morton’s neuroma is often diagnosed clinically, although X-rays, ultrasound or MRI may be arranged where needed.
Surgery may be considered when symptoms remain troublesome despite appropriate non-surgical treatment and the diagnosis is sufficiently clear.
In selected cases, yes. An injection may help reduce symptoms and may also help confirm the source of pain, depending on the clinical findings.
Wider, roomier footwear is often more comfortable than tight or narrow shoes, especially if pressure over the forefoot worsens symptoms.