Morton’s Neuroma: A Complete Guide to Symptoms, Diagnosis, and Treatment
Morton’s neuroma is a painful thickening and fibrosis around a digital nerve where it passes beneath the deep transverse metatarsal ligament. The third web space is most often involved, although any interspace can be symptomatic. Women are affected more often than men, likely because forefoot compressing shoes raise interdigital pressure.¹²³ ⁴
Symptoms
People commonly report:
Sharp or burning pain under the ball of the foot that may shoot into adjacent toes.²
Numbness or tingling between the involved toes.²
The feeling of a pebble in the shoe.²
Worsening pain in narrow or high heeled shoes, relief when shoes come off or the forefoot is massaged.²
Diagnosis
Clinical examination
Thumb index squeeze test
Compress the forefoot side to side while pressing the tender web space. This is the best bedside screen with about ninety six percent sensitivity and excellent overall accuracy.⁵Mulder click
A palpable or audible click can be specific when present, although it is less sensitive. A negative click does not rule out a neuroma.⁵ ⁶
When to image
If history and exam are classic, begin treatment without imaging. Image when symptoms are atypical, when multiple sites are suspected, when conservative care fails, or before a procedure.³ ⁷
Ultrasound versus MRI
Meta analyses and comparative studies show ultrasound and MRI have similar sensitivity and overall accuracy for Morton’s neuroma. Ultrasound adds real time correlation with the exact tender spot and can guide injections, which is why it is my usual first study.²³ Biggest issue with ultrasound is finding a good musculoskeletal sonographer who is used to looking for this condition.
Conservative treatment
Footwear that helps
Toe box shape
Choose a wide and deep toe box to let the metatarsal heads splay. Toe box geometry measurably changes interdigital and plantar pressures.⁴Rocker profile and cushioning
A gentle forefoot rocker and adequate cushioning lower peak forefoot pressure and smooth push off. Reviews and experimental work support meaningful pressure drops with rocker designs.⁸ ⁹ ¹⁰
Topo Atmos
Roomy anatomical toe box with max cushion. Works well with a met pad or a prefabricated insole.Brooks Ghost Max 3
Smooth forefoot rocker and multiple width options to control volume without sizing up.
Metatarsal pad placement and orthotics
Metatarsal Pads to use on your own shoe’s insole: Place the dome just behind the metatarsal heads so it hugs the sore web space rather than sitting on it. Small adjustments of five to ten millimeters can change comfort a lot
Sticker backed felt metatarsal pads quarter inch
Low profile domes for precise placement behind the met heads. Best to think of them as a way to splay or push the metatarsals apart slightly to keep them from pinching the nerve and therefore aggravating the neuromaPrefabricated OTC insoles with a built in metatarsal support can spread load across the forefoot and shift weight proximal
PowerStep Pinnacle Plus Met insoles
Built in met support that helps distribute pressure. The next step up. Using an insole with a metatarsal pad helps shift weight to the middle of your foot and helps with splaying the metatarsals to decrease pinch of the nerve
Activity modifications
For two to four weeks favor level walking, cycling with a stiff sole, or pool work while symptoms cool. Reassess shoe fit in the afternoon when feet are at their largest.²
Other helpful measures
Short courses of anti inflammatory medication like ibuprofen or Mobic, targeted physical therapy for foot mechanics and toe mobility, and simple padding or taping can assist recovery.²
Injections
Corticosteroid injections
Randomized and systematic evidence shows many patients gain short to medium term relief. Ultrasound guidance did not clearly outperform careful landmark technique when the diagnosis was straightforward.¹³ ¹⁴ For most patients, I explain, the goal of these injections is to shrink the nerve enough that their new reliance on metatarsal pads and wider toe boxed shoes can allow the nerve to heal itself. Very high success rates in my practice
Alcohol sclerosing injections
Research shows strong early relief, yet five-year data demonstrate deterioration for many and a sizable conversion to surgery. Many patients complain of the pain and you need 6+ injections for most protocols. Due to the pain, long treatment course, and proportion that go on to surgery, I no longer offer this in my private practice. ¹⁵
When surgery makes sense
Indications
Consider surgery after you have tried to optimize footwear, correct metatarsal pad placement, and one or two well targeted injections fail over three to six months and symptoms continue to limit activity.¹⁶ ¹⁷
Options
Neurectomy
Removal of the diseased nerve segment. High rates of pain relief in large series, with expected numbness in the involved web space.¹⁶ ¹⁷Decompression
Release of the deep transverse metatarsal ligament to offload the nerve while preserving sensation. Outcomes are favorable and this may be preferred in select anatomy or smaller neuromas.¹⁶ ¹⁸
Standard Neurectomy Incision
My typical incision to perform a neurectomy. Usually these are performed in office under local anesthesia. Patient’s can walk themelves in and walk themselves in their own shoes.
Recovery timeline post operative
Week one to two: protected weight bearing in a surgical shoe.¹⁶
Weeks three to four: gradual return to regular footwear.¹⁶
Months two to three: progressive return to full activities. Residual numbness after neurectomy is common and usually not bothersome.¹⁶
Morton’s neuroma in children
True Morton’s neuroma is rare in kids. Think first about overuse metatarsalgia, plantar plate irritation, toe box crowding in cleats, and uncommon soft tissue masses that mimic neuroma.
Start with wider shoes, simple metatarsal pads, and activity changes. Reserve imaging for atypical or persistent cases. This matches the footwear philosophy we share in our Pediatric Intoeing guide.²
Prevention
Choose shoes with adequate toe box room for natural splay.⁴
Limit prolonged time in high heels.²
Maintain calf flexibility and toe mobility to support normal mechanics.²
Address forefoot deformities that increase pressure.²
Listen to symptoms early, since early changes are easier than late fixes.²
When to see a Podiatrist
Book a visit if forefoot pain persists beyond a few days, if numbness or tingling is present between toes, if walking is limited, or if symptoms do not improve with basic footwear changes.² ³
Frequently asked questions
Can a neuroma go away without treatment
Early cases can improve with wider toe boxes, a gentle rocker, and correct metatarsal pad placement. Established neuromas usually require active treatment.¹¹ ¹²
How long until conservative care helps
Most people notice improvement within two to four weeks. Full resolution often takes two to three months.²
Will I definitely need surgery
No. Many if not most achieve durable relief with shoe shape, a well placed met pad, and a simple injection plan.¹³ ¹⁴
Can symptoms return after surgery
Recurrence can happen, although contemporary reviews show high satisfaction and pain relief for most patients.¹⁶ ¹⁷
Products Actually Used or Recommended In My Practice for Morton’s Neuromas:
These items are listed for education purposes and references only, not to replace seeing your provider for specific recommendations, I may receive commission for any items purchased.
Wide Toe Boxed Shoes: Primarily I recommend Topo Atmos for their anatomic toe boxes. I personally wear the Brooks Ghost Max 3 and find the new toe box on this iteration to be very spacious too. Huge upgrade from the Ghost Max 2
OTC insoles: Powerstep inserts with metatarsal pads made in to them already The same brand recommended other places on the site but this time with a special pad under the ball of the foot to help relieve pressure on the neuroma
Sticker back felt metatarsal pads can be used to make the insole in your current shoe a neuroma offloading power house! Place it just behind, not under, the metatarsal head aka the “ball of the foot”. If you place it directly under the ball of the foot and you’ll likely end up with more pain.
References
Munir U, et al. Morton Neuroma. StatPearls. 2023.
Bignotti B, et al. Ultrasound versus magnetic resonance imaging for Morton neuroma. Meta analysis. Eur Radiol. 2015.
Xu Z, et al. The accuracy of ultrasonography and magnetic resonance imaging for Morton neuroma. Clin Radiol. 2015.
Branthwaite H, Chockalingam N, Greenhalgh A. The effect of shoe toe box shape and volume on interdigital and plantar pressures. J Foot Ankle Res. 2013.
Mahadevan D, et al. Diagnostic accuracy of clinical tests for Morton’s neuroma. Foot Ankle Int. 2015.
Radiopaedia. Mulder sign. Updated 2025.
Santiago FR, et al. Role of imaging methods in diagnosis and treatment of Morton’s neuroma. Skeletal Radiol. 2018.
Ahmed S, et al. Footwear and insole design features that reduce plantar pressure. Systematic review. Gait Posture. 2020.
Preece SJ, et al. Optimisation of rocker sole footwear for forefoot peak pressure reduction. J Foot Ankle Res. 2017.
Malki A, et al. Individually optimised rocker midsoles and self adjusting insoles reduce forefoot pressures. Sci Rep. 2024.
Landorf KB, et al. Effects of metatarsal domes and optimal position relative to the metatarsal heads. J Foot Ankle Res. 2020.
Hsi WL, et al. Optimum position of metatarsal pad in metatarsalgia for pressure relief. Am J Phys Med Rehabil. 2005.
Mahadevan D, et al. Corticosteroid injection for Morton’s neuroma with or without ultrasound guidance. Randomised controlled trial. Foot Ankle Int. 2016.
Choi JY, et al. Corticosteroid injection for Morton’s interdigital neuroma. Systematic review. Foot Ankle Surg. 2021.
Gurdezi S, et al. Alcohol injection for Morton’s neuroma. Five year follow up. Foot Ankle Int. 2013.
Zhang J, et al. Effect of surgical approach on treatment of Morton’s neuroma. Systematic review and meta analysis. Foot Ankle Surg. 2023.
Lee W, et al. Postoperative outcomes after neurectomy for Morton’s neuroma. Systematic review and meta analysis. Foot Ankle Surg. 2024.
Koti M, et al. Long term results after dorsal neuroma or nerve transposition and review of decompression literature. Foot Ankle Surg. 2022.
