Morton's Neuroma

Overview

what it is and why it matters

Morton's neuroma is a thickening of one of the small nerves between the bones of your forefoot. Despite the name, it is not a true tumor; it is chronic scarring and swelling around the nerve. Most often it shows up between the third and fourth toes. The cause is repetitive compression of the nerve from narrow toe boxes and high heels. The classic symptom is burning forefoot pain or tingling between the toes. Many patients describe it as feeling like they're stepping on a marble or a folded-over sock.

Symptoms

what you may notice

Burning pain between the toes, most often between the third and fourth toes, worsened by tight or narrow shoes
Marble-in-the-shoe sensation, feeling like you're stepping on a pebble or a bunched-up sock under the ball of your foot
Numbness or tingling, radiating into the affected toes as the swollen nerve is compressed
Relief with shoe removal, symptoms often ease quickly when you take the shoe off and massage the forefoot

Diagnosis

exam first, imaging second

Morton's neuroma is usually a clinical diagnosis, meaning a focused physical exam of the forefoot is often enough to recognize it. A foot-and-ankle clinician presses on the painful web space and squeezes the forefoot to reproduce the pain. Ultrasound confirms the thickened nerve and is also used to guide injections. MRI is an alternative. Standing X-rays rule out other forefoot problems that can mimic the symptoms.

Treatment Path

how care progresses

Care for Morton's neuroma builds up in steps, and each one is added on top of the last rather than replacing it. We start with the simplest changes, footwear and padding, because for many patients that is all it takes. The treatments below are listed in the order we usually introduce them.

Wide toe-box footwear

Wider, softer shoes that don't squeeze the forefoot, the single most important first step. For many patients, just changing footwear is enough.

Metatarsal pad

A small pad placed just behind the painful spot lifts and spreads the bones apart slightly, taking pressure off the irritated nerve.

Corticosteroid injection

A corticosteroid injection placed precisely between the bones, guided by ultrasound, relieves symptoms in 50 to 70 percent of patients.

Sclerosing ethanol injection
A series of dilute alcohol injections can chemically destroy the nerve over several sessions, an alternative to surgery for refractory cases.

Surgical Options

if non-operative care isn't enough

Surgical removal of the thickened nerve is offered after non-operative care (footwear changes, padding, and at least one injection cycle) hasn't given lasting relief. The trade-off: the nerve is gone, which means permanent numbness in a small patch between the affected toes. Most patients consider that a worthwhile trade for being out of pain.

Frequently Asked

questions we hear in clinic

Is a Morton’s neuroma a tumor?

No. Despite the name, it is not a true tumor. It is chronic scarring and swelling around one of the small nerves between the bones of your forefoot, most often between the third and fourth toes.

Why does it feel like I’m stepping on a marble?

The swollen nerve sits under the ball of the foot, so pressure on it produces a marble-in-the-shoe sensation, as if you were stepping on a pebble or a bunched-up sock. Many patients also notice burning pain or tingling that radiates into the affected toes.

What causes it?

Repetitive compression of the nerve. Narrow toe boxes and high heels squeeze the forefoot and irritate the nerve over time.

Do I need an MRI to diagnose it?

Usually not. Morton’s neuroma is generally a clinical diagnosis based on a focused exam of the forefoot. Ultrasound confirms the thickened nerve and can guide injections; MRI is an alternative. Standing X-rays are used to rule out other forefoot problems that can mimic the symptoms.

What can I do on my own first?

Switch to wider, softer shoes that don’t squeeze the forefoot. That is the single most important first step, and for many patients just changing footwear is enough. A metatarsal pad placed just behind the painful spot can also take pressure off the irritated nerve.

How well do cortisone injections work?