Do you have Morton’s neuroma or pain under your toes? Are you unsure about the diagnosis of your pain?
Are you looking for answers on what causes it and the treatment options available with or without surgery.
I draw a conclusion based on both published studies and my own knowledge as a radiographer.
Happy reading!😀 and feel free to ask questions in the comments or share your own experience.🙏
Last updated: June, 2025. Written by Juliet Semakula, a diagnostic radiographer.
▶️ What is Morton’s neuroma of the forefeet?
Morton’s neuroma is a special type of neuroma in the foot. More specifically, it affects the plantar interdigital nerve, which runs between the 3rd and 4th metatarsal bones, along the line of your toes.
Morton’s neuroma is a common pathology that affects the forefoot. It is not a true neuroma but is fibrosis of the nerve.
By this we mean fibrosis connective tissue thickens or scars around a nerve creating an abnormal build-up of scar tissue around and within the nerve itself due to different reasons.
Image from nhs.uk
The thickening can lead to nerve compression potentially causing pain, numbness, tingling, or weakness in the affected area of your feet.
▶️Some people wonder if Morton’s neuroma is a form of arthritis.
No, Morton’s neuroma is not a form of arthritis. Arthritis is a condition that involves inflammation of the joints.
Their causes and treatments differ significantly, the only common factor is that they both cause foot pain.
▶️What does neuroma pain feel like? signs you may have with Morton’s syndrome.
People who usually are diagnosed with neuroma syndrome, come in x-ray complaining of pain in the forefoot. They normally describe it:
⚪As a feeling of a sharp, burning, or stabbing pain in the ball of the foot, often radiating into the toes localised in one area.
⚪It can also feel like a pebble or lump is stuck under the foot and may be accompanied by tingling or numbness.
⚪The pain becomes aggravated by wearing tight shoes or engaging in activities that put pressure on the foot.
⚪You are a woman or you are 40 to 60 years old
▶️How can you be sure that your foot pain is really Morton’s syndrome?
There are two key indicators that normally confirm pain associated with Morton’s syndrome.
| 1️⃣When you have a burning or shooting pain and numbness between the toes, particularly the 3rd and 4th toe. Most patients state that the pain is worsened by walking in their bare feet and can be alleviated by wearing dress shoes 2️⃣You feel a Mulder’s click when squeezing the foot, which normally suggests the condition especially without trauma to the feet. |
These criteria increase the likelihood that this is the case.
However, when you go to the doctors with pain in the forefoot. A podiatrist will do a clinical examination of your foot looking for tenderness, swelling and other signs of Morton’s neuroma.
A positive test confirms the presence of the neuroma.
But even if the test is negative, that doesn’t rule out the possibility that you actually have a neuroma.
Image showing thumb index finger squeeze test (image from Santiago,2018
An MRI scan or ultrasound may be requested to help rule out other cases if your doctor has doubts in case of stress fracture of the metatarsal bone.
▶️Can Morton’s neuroma turn cancerous?
No, Morton’s neuroma cannot turn cancerous, it is a type of neuroma, which technically means a nerve tumour. However, these tumours are benign and do not spread or metastasize
But it is normal for you to have thoughts of the severe pain being a sign of malignant tumour.
To reassure you, while it can cause pain, numbness, and tingling, it does not have the potential to become malignant, and it is not even a symptom of any type of cancer, nor does it cause it.
▶️What triggers Morton’s neuroma? Causes
Many theories have been proposed regarding the exact causes of Morton’s neuroma for example studies by (Adams,2010) state some of the causes.
⚫Insufficient blood supply to the nerve (Ischemia)
⚫Presence of an intermetatarsal bursa.
⚫Pronation.
⚫Trauma or injury to the foot such as fractures or sprains can lead to nerve damage.
⚫Anatomic thickness of the nerve in the third interspace.
However, people diagnosed with neuroma syndrome after a clinical examination outline these contributing factors likely to cause the condition.
⚫Morton’s neuroma is caused by nerve compression or irritation, often due to tight or narrow shoes which can compress the nerves between the metatarsal bones.
⚫High-impact activities that put repetitive stress on the ball of the foot, such as running, racquet sports, or even prolonged standing, can contribute to nerve irritation and neuroma development.
⚫Foot deformities such as bunions, hammertoes and flat feet which can alter foot mechanics and increase pressure on the nerves
⚫Being overweight sometimes increases pressure on the feet, potentially aggravating existing nerve irritation.
▶️ What type of treatment is available for Morton’s neuroma?
Treatment for Morton’s neuroma is managed non surgically, and the aim is to decrease pressure and irritation of the nerve.
There are different therapeutic non-surgical treatments used to help treat the pain and discomfort.
Adjustment of footwear and physical activity
⬜Choose shoes with the widest possible forefoot.
⬜ Metatarsal bar is the common form of treatment initially given. This insole, made by orthotists spreads the heads of the metatarsals to relieve pressure on the neuroma and thus improve symptoms.
⬜Avoid heels.
This requires you to wear broad toe box shoes and use the inserts, so a degree of compliance is required.
However, there is no evidence to support the use of inversion or eversion insoles, with studies demonstrating no significant improvement in patient reported outcomes
Bhatia,2020
Injection therapy
⬜The use of therapeutic injections is very common in the management of Morton’s neuroma; The injection can be guided by US scan.
Displacement of Morton’s neuroma using ultrasound scan applying Pressure on the dorsal aspect of the web space (A) and Morton’s neuroma injections being applied (B) (Santiago,2018)
People who have got this injection claim to have pain after three months of having the injection.so this kind of treatment is for a short-term pain relief improvement.
A review of people for over 3 months in the group of patients who had US scan guided injections was better, but the effect was not sustained at 6 months (Santiago,2018)
Medication
Medications that are sometimes prescribed or offered include:
⬜Non-steroidal anti-inflammatory drugs (NSAIDs).
⬜Anecdotally amitriptyline (an antidepressant).
There are no studies comparing the development of people with Morton’s neuroma who take this or that drug with that of people who do not take it
Movement therapy, physiotherapy and manual therapy
The type of therapy will depend on your physical therapist assessment and your personal preferences.
⬜Muscle strengthening and foot mobilisation exercises.
⬜Massage, shock waves and manual therapy.
⬜Support in adjusting the type of physical activity and lifestyle to help you manage pain.
Surgical option
When conservative management fails and pain persists, normally your doctor may suggest surgery.
There are two approaches that are normally used to remove neuroma syndrome.
1️⃣A dorsal approach: this surgical method allows you to weigh the bear immediately and most people can tolerate it.
A review where a dorsal surgical approach was performed in 82 patients.
➡️85% reported good outcomes and immediate walking on the foot.
➡️65% had no pain for over 6 years after the procedure.
➡️40% had poor results, felt pain after surgery in the following months.
Womack,2008
Image showing a Dorsal approach for Morton’s Neuroma removal. Bold arrow shows Morton’s Neuroma (image from Bhatia 2020)
2️⃣A planter approach: this surgical approach is normally not used and there is a risk of wound complications and scar sensitivity.
A prospective study done on only 17 people who had neuroma where a plantar approach was used 80% were able to return to pre-surgical footwear (Bhatia,2020).
However, no studies have proven the benefits over one or the other.
▶️What are possible complications after surgery?
Both approaches do have possible complications such as:
🔴A possibility of recurrent or stump neuroma, which may be caused by not resecting the nerve proximal enough, incomplete removal, or tethering of the nerve to the plantar aspect of the metatarsophalangeal joint (Adams,2010)
🔴There is a risk of wound complications (infection) and scar sensitivity.
🔴Swelling and Stiffness which may take 6 months to completely go away.
🔴Permanent numbness of the toes.
🔴Blood clot, there is small risk of developing a blood clot after foot surgery. Thou measures are taken to reduce the chance of this happening but cannot be completely avoided.
🔴Chronic regional pain syndrome.
▶️How long does recovery take after treatment when you have Morton’s neuroma.
There are no studies that follow the development of people diagnosed with a neuroma and compare the development of those who undergo treatment with those who do not.
So, we don’t really know how Morton’s neuroma develops without treatment and whether and how long it takes until it disappears on its own.
The only reviews we have is the recovery time-line after surgical treatment and when symptoms start to improve after conservative management. Recovery varies significantly depending on the treatment method you have got.
⚫If you were told to rest your feet and use orthotics, you may start seeing improvement within a few weeks to months.
⚫If you had surgery recovery will take you longer ranging from a few weeks to several months.
⚫You will be seen two weeks after surgery in the outpatient clinic. Your wounds will be checked and the stitches removed.
If the wound has healed, you can then start wearing your own footwear. You will then be seen again six weeks after surgery to check on your progress.
⚫Full healing can take up to a year, and some patients may experience persistent numbness or pain
Here is a table with a proposed recovery timeline after surgery.
| Phase after surgery | Timeline |
| Initial Few Weeks swelling and stiffness is common and pain and tenderness in the ball of the foot is normal | Swelling will subside within 2-4 weeks, or it may take 6 months to go away. And pain will reduce as well.Some people return to normal shoes and work. |
| Normal activities can be resumed | 4-8 weeks |
| Sports | Avoid high impact exercises for at least six weeks and return gradually as your comfort levels allow. |
| When to drive again | You can start driving when you are comfortably walking in your own footwear |
| return to most of your previous activities | 6 weeks to 3 months |
| Return to work | If you have a desk-based job and you can elevate your foot, you can return to work two weeks after surgery, you may need longer until you feel better to walk with no pain. |
| Injections | Corticosteroid injections may provide 3- 6 months temporary pain relief |
| Cryogenic Surgery involves freezing the nerve | May allow for a quicker return to daily activities, often within a few days of rest. |
| Neurectomy (Nerve Removal) | Potentially 1-6 weeks or even longer. |
| Full healing | Up to 12 months |
▶️Does walking aggravate Morton’s neuroma?
Yes, walking can aggravate Morton’s neuroma especially when you over do it.
However, walking can promote blood circulation and maintain joint flexibility and minimise stiffness.
How you can decide if walking is good for you or not.
Try the conservative management by wearing supportive footwear, reduce prolonged activities if you feel the pressure is causing your pain.
If you have had surgery, you will be advised to rest your feet:
⚫In the first few weeks after treatment, it is advisable to keep your leg elevated as much as possible to help reduce the swelling and aid wound healing.
Before you go home the physiotherapist will make sure you are safe to get around on crutches in the first few weeks.
Then depending on how you feel, you can fully weight bear through the operated leg.
▶️What happens if you ignore Morton’s neuroma?
Ignoring Morton’s neuroma can lead to worsening pain, increased nerve damage, and potential complications.
Initially, the pain may be intermittent, but without treatment, it can become more frequent and intense, even causing constant pain when not wearing shoes.
This can lead to altered walking patterns and secondary issues in other parts of the body, as well as potential permanent nerve damage.
Always consult your podiatrist who can provide personalised advice, diagnosis and treatment in your case.
▶️Is Morton’s neuroma classed as a disability?
Here in the United Kingdom under the Equality Act 2010, Morton’s neuroma is not automatically classified as a disability.
But it can be considered a disability if the condition has a substantial and long-term negative effect on your ability to perform normal day-to-day activities.
We have come to the end of this article and I hope I have answered some of your common questions. Any questions in the comments section.
Wishing you a quick recovery.🙋
📚Sources
Bhatia M, Thomson L. Morton’s neuroma – Current concepts review. J Clin Orthop Trauma. 2020 May-Jun;11(3):406-409. doi: 10.1016/j.jcot.2020.03.024. Epub 2020 Apr 10. PMID: 32405199; PMCID: PMC7211826.
Bhatia M, Thomson L. Morton’s neuroma – Current concepts review. J Clin Orthop Trauma. 2020 May-Jun;11(3):406-409. doi: 10.1016/j.jcot.2020.03.024. Epub 2020 Apr 10. PMID: 32405199; PMCID: PMC7211826.
Womack JW, Richardson DR, Murphy GA, Richardson EG, Ishikawa SN. Long-term evaluation of interdigital neuroma treated by surgical excision. Foot Ankle Int. 2008 Jun;29(6):574-7. doi: 10.3113/FAI.2008.0574. PMID: 18549752.
Santiago FR, Muñoz PT, Pryest P, Martínez AM, Olleta NP. Role of imaging methods in diagnosis and treatment of Morton’s neuroma. World J Radiol. 2018 Sep 28;10(9):91-99. doi: 10.4329/wjr.v10.i9.91. PMID: 30310543; PMCID: PMC6177560.
Adams WR 2nd. Morton’s neuroma. Clin Podiatr Med Surg. 2010 Oct;27(4):535-45. doi: 10.1016/j.cpm.2010.06.004. PMID: 20934103.