Morton’s neuroma is a thickened, irritated nerve between two toes, most often the third and fourth. It causes burning, tingling or the feeling of a PEBBLE in your shoe, and most people get better without surgery.
Start with the simple things:
- wider shoes with a low heel,
- a pad that spreads the bones, and
- less time in tight or high shoes
About half of people improve with those changes alone.
Injections are the next step if that isn’t enough. Surgery is kept for pain that hasn’t settled after 3 to 6 months of proper treatment, and it comes with a trade-off you should know about before you agree to it.
What it feels like
- Burning or sharp pain in the ball of the foot: usually between the third and fourth toes, sometimes between the second and third
- A pebble or marble feeling: as if your sock is folded under your foot, even when nothing is there
- Tingling or numbness: shooting into the two toes on either side of the nerve
- Worse in tight shoes and heels: better when you take the shoe off and rub the front of the foot
- Nothing to see: the foot usually looks normal. There’s no lump you can spot from the outside
What’s going on
The nerves that supply the toes run between the long bones of the forefoot (the metatarsals).
When those bones are squeezed together again and again, the nerve between them gets pinched, swells and thickens. Despite the name, it isn’t a tumor, and it isn’t cancer.
- Who gets it: far more common in women, mostly between the ages of 30 and 60
- Tight or pointed shoes: they squeeze the metatarsals together, with the nerve in between
- High heels: they push your weight forward onto the ball of the foot, right where the nerve runs
- Running and court sports: repeated pressure through the forefoot, step after step
- Foot shape: bunions, hammertoes, flat feet or a high arch change how load spreads across the front of the foot
If the pain is an ache under the ball of the foot without burning or tingling, see metatarsalgia.
If one spot on a bone is very tender and the pain started after more running or walking, see stress fracture in the foot.
What helps
- Wider shoes: a roomy toe box so the forefoot isn’t squeezed, a low heel and a cushioned sole. This is the most important change you can make
- A metatarsal pad: a small dome that sits just BEHIND the sore spot, not on it. It lifts and spreads the bones so the nerve has more room. If it makes things worse, move it back a little
- Cushioned insoles: they soften the impact through the forefoot, especially if you stand for long periods
- Less time in what squeezes the foot: fewer hours in heels, narrow work boots or tight sports shoes. Swap some running for cycling or swimming for a few weeks
- Pain relief: anti-inflammatory tablets such as ibuprofen can take the edge off a flare, if they suit you
- Shoe off, foot rubbed: when it flares, this eases the nerve. It’s also a useful clue that a neuroma is the cause
Give the nerve room and it usually calms down. Keep squeezing it and it keeps complaining.
Injections
- Cortisone shot: an injection of steroid next to the nerve. It helps roughly half to two-thirds of people, but often only for a while. Repeated shots can thin the fat pad under the ball of the foot, so most doctors limit how many you have. See cortisone shot side effects
- Nerve-calming procedures: some clinics offer alcohol injections, or treatments that use heat or cold to quieten the nerve. Results vary and the evidence is still limited, so ask what results that clinic gets and what happens if it doesn’t work
Surgery
Surgery is usually offered when symptoms haven’t improved after 3 to 6 months of good treatment, or keep coming back.
- Freeing the nerve (decompression): the surgeon releases the tight ligament above the nerve to give it more room. Feeling in the toes is kept
- Removing the nerve (neurectomy): the thickened section of nerve is cut out
- The trade-off: after removal, the skin between the two toes can be numb, and that numbness can be PERMANENT. For many people it’s a fair swap for losing the pain, but go in expecting it
- Results: about 3 in 4 people are pain-free afterward, and more are improved. Some get pain again, sometimes because the cut end of the nerve forms a new lump, called a stump neuroma
- Recovery: walking in a stiff-soled post-op shoe within days, normal shoes by about 4 weeks, and high-impact exercise a few weeks after that, once your surgeon agrees
The American Academy of Orthopaedic Surgeons has a clear guide to Morton’s neuroma and its treatment options.
Get seen today if
- The foot is red, hot and swollen, or you have a fever
- A toe turns pale, blue or cold
- You have diabetes and notice a new sore, blister or color change on the foot
- You can’t put weight on the foot after a fall or a twist
Get it checked if
- Numbness is spreading beyond the two toes, or into the sole or heel
- Both feet burn or tingle, especially at night. That pattern points more to a nerve problem elsewhere, such as from diabetes
- You can see or feel a lump on top of the foot, or swelling that doesn’t settle
- Nothing has improved after 2 to 3 months of wider shoes and a pad
- Pain came back after surgery, especially a sharp, electric pain near the scar
Squeezing wakes the nerve up. Room is what lets it settle.