Morton’s neuroma is a painful condition caused by thickening and irritation of a nerve in the forefoot, most often between the third and fourth toes. It commonly feels like walking on a pebble, with burning, stabbing, tingling, or numbness in the ball of the foot, and symptoms are often worsened by tight shoes, high heels, or repetitive forefoot loading such as running.
Morton’s Neuroma in the Foot
Morton’s neuroma is a compressive neuropathy affecting the interdigital nerve, usually in the third intermetatarsal space and less commonly in the second. Although it is called a neuroma, it is not a true tumour; rather, it is a fibrotic enlargement and irritation of the nerve caused by chronic pressure or traction. The condition is most often discussed in relation to female patients and people who frequently wear narrow or high-heeled footwear, though it can occur in anyone exposed to repetitive forefoot stress
Causes and Risk Factors
The exact cause of a Morton Neuroma is not always clear, but the condition is strongly associated with mechanical compression of the nerve. Tight toe boxes, pointy shoes, and high heels increase pressure across the forefoot, while running and other high-impact activities can repeatedly irritate the nerve. Foot structure also matters: bunions, hammertoes, flat feet, and high arches may alter load distribution and contribute to nerve irritation.
Symptoms and Clinical Features
The classic symptom of a Morton’s neuroma is sharp or burning pain in the ball of the foot, usually radiating into the adjacent toes. Many people describe a sensation of “walking on a marble” or having a stone stuck under the foot. Tingling, numbness, or pain that increases when standing, walking, or wearing restrictive shoes is also common.
Diagnosis
Diagnosis is usually clinical, based on the history and location of pain. A clinician may reproduce symptoms by squeezing the forefoot or by palpating the affected web space, and imaging such as ultrasound or MRI can be used when the diagnosis is unclear or when other conditions need to be excluded. Because forefoot pain can also come from metatarsalgia, stress fracture, plantar plate injury, or intermetatarsal bursitis, a careful differential diagnosis is important.
Conservative Treatment
Initial treatment is usually non-surgical. The most important step is reducing pressure on the nerve by switching to wide, supportive shoes with a low heel and soft sole, and by avoiding tight or pointy footwear. Padding, soft insoles, activity modification, and reducing running or jumping may also ease symptoms. If pain persists, corticosteroid injections, custom orthoses, or other specialist treatments may be considered.
Surgical Management
Surgery is generally reserved for persistent cases that do not respond to conservative care. The main procedures are decompression of the nerve or excision of the affected nerve segment, and both can provide good pain relief in selected patients. A key trade-off is postoperative numbness in the toes supplied by the removed or released nerve, which patients should understand before deciding on surgery.
Morton’s neuroma is a common and often frustrating cause of forefoot pain, but it is usually manageable once correctly identified. Because symptoms are closely linked to shoe choice and loading patterns, early treatment often focuses on reducing compression and improving foot mechanics. For persistent cases, injections or surgery may be needed, but many patients improve with appropriately targeted conservative care.