Morton's neuroma

What is Morton's neuroma, and how common is it?

Morton's neuroma is a painful condition of a nerve in the ball of your foot. It's most often found between the third and fourth toes, and less often between the second and third¹. You may also hear it called interdigital neuroma or Morton's metatarsalgia.

Despite the name, it isn't a cancer or a true tumour. The nerve between the long bones of your forefoot becomes swollen and irritated². After carpal tunnel syndrome (a wrist condition), it's the most common nerve-squeezing problem in the body¹.

What causes Morton's neuroma, and who gets it?

The exact cause isn't known. It seems to start when a nerve in the forefoot is repeatedly squeezed, rubbed or stretched³. Commonly listed contributors are narrow or thin-soled shoes such as high heels, bunions or hammer toes, being overweight, tight leg muscles, and long periods of standing, walking or running, especially after a sudden increase in activity³.

Even so, the strongest review found the evidence inconclusive for tight footwear, so no one thing can be blamed for your neuroma¹.

It's most often seen in women in their late 40s or early 50s. Many are active, and running and dancing are linked with it⁴.

What does it feel like, and how is it diagnosed?

Pain usually starts in the ball of the foot and can spread into the toes. You may also feel burning, tingling or numbness between the affected toes, or as if you're walking on a pebble or have a lump under your foot⁵. It tends to be worse in tight shoes and when standing or walking. Taking your shoes off and massaging the area often eases it³.

A podiatrist or doctor will ask about your symptoms and examine your foot, including gently squeezing it². No single test or sign is enough on its own to confirm it¹. An ultrasound or MRI scan can show an enlarged nerve, but an enlarged nerve doesn't always cause symptoms, so scans are read alongside your examination¹.

Other forefoot problems can feel similar, and some can occur alongside a neuroma. These include a strain of the plantar plate (a supporting structure under the toe joint), bursitis (inflamed fluid sacs between the toe bones) and a stress fracture⁶⁷. That's a good reason to have the pain examined rather than guessing.

What can I do first?

Simple care comes first, and much of it you can do yourself.

• Change your shoes. Choose shoes with a deep, wide toe box, a low heel and a thick sole that isn't overly flexible. Avoid narrow, pointed or high-heeled shoes⁸³.
• Ease what brings the pain on, and try calf and foot stretching⁴.
• Ask a podiatrist about orthoses (shoe inserts). Many people find their pain improves or resolves with a plan that includes shoe changes, stretching and orthoses⁹.

No single non-surgical treatment has been shown to be the best, and good-quality trials are lacking¹⁰. Give your plan some time: if there's no noticeable change after six to twelve weeks, or your pain flares markedly after exercises, have it reviewed⁵.

What helps if that isn't enough?

The usual next step is an injection of a corticosteroid (an anti-inflammatory medicine) with local anaesthetic. The results are mixed: injections guided by ultrasound probably reduce pain and improve function, while injections without guidance may make little difference¹. Possible side effects include thinning or paler skin and thinning of the fat pad under the ball of the foot¹. It's worth asking whether your injection will be ultrasound-guided.

Surgery removes the part of the nerve causing the pain, and is considered only after non-surgical care hasn't worked². The sides of the two toes that nerve supplied will be permanently numb¹¹. A small number of people have ongoing pain at the cut end of the nerve and need more surgery². The risk of infection after surgery is higher if you have diabetes or rheumatoid disease, or if you smoke². Talk these through before you decide.

How long does it take to get better, and can it come back?

How long it takes varies, and a typical recovery time with non-surgical care isn't clear yet. Severe cases can affect your walking, your activities and your quality of life¹, so it's worth getting help rather than putting up with it.

Once symptoms settle, keep wearing roomy shoes with a low heel, a wide toe box and a thick sole⁷, and build up running or walking gradually rather than suddenly. It isn't clear yet whether these habits stop it coming back. If your symptoms return, get them reviewed rather than waiting⁵.