Morton’s neuroma is a damaged, enlarged nerve in the ball of your foot that causes pain, burning, or numbness between your toes. It most commonly develops in the space between the third and fourth toes, where a nerve runs between the long bones (metatarsals) of the forefoot. The condition affects roughly 30% to 33% of people who experience foot pain, and it’s at least five times more common in women than men, particularly between the ages of 25 and 55.
What Happens Inside Your Foot
Despite its name, Morton’s neuroma isn’t a true tumor. It’s a thickening of tissue around the nerve that travels between your metatarsal bones to supply sensation to your toes. When that nerve gets compressed or irritated repeatedly, the surrounding tissue swells and the nerve itself enlarges. Over time, this creates a painful mass in the ball of your foot, sometimes called an interdigital neuroma.
The third web space (between the third and fourth toes) is the most frequent location, though it can also develop between the second and third toes. Having it in both spots simultaneously is less common but possible.
What It Feels Like
The hallmark sensation is feeling like you’re standing on a pebble or a fold in your sock, even when there’s nothing there. Many people describe a sharp, burning pain in the ball of the foot that radiates into the affected toes. Numbness or tingling between the toes is also common. Symptoms tend to flare up during walking or standing, especially in tight shoes, and ease when you sit down, take your shoe off, or rub the area.
Early on, symptoms may come and go. You might notice discomfort only after a long walk or a workout. As the nerve thickening progresses, pain can become more persistent and harder to relieve simply by resting.
Causes and Risk Factors
Anything that compresses or irritates the nerve repeatedly can trigger a neuroma. The most common culprits include:
- Footwear: High heels and shoes with narrow, pointed toe boxes push the metatarsal bones together, squeezing the nerve.
- High-impact sports: Running, tennis, and other racquet sports place repetitive pressure on the ball of the foot.
- Prolonged standing: Jobs that keep you on your feet all day increase the cumulative load on the forefoot.
- Foot shape: Flat feet, high arches, bunions, and hammertoes all change the way force distributes across the forefoot, making the nerve more vulnerable.
- Injuries: A prior foot injury from sports or trauma can set the stage for nerve irritation.
How It’s Diagnosed
Diagnosis usually starts with a physical exam. Your doctor will press on the space between your metatarsal heads and may squeeze the forefoot side to side. This maneuver, called Mulder’s test, sometimes produces an audible or palpable click as the neuroma shifts between the bones. That said, the test catches the neuroma about 61% of the time, so a negative result doesn’t rule it out.
When imaging is needed, both ultrasound and MRI are equally accurate. A meta-analysis comparing the two found ultrasound detected neuromas 91% of the time, while MRI detected them 90% of the time, with no meaningful difference between the two. Ultrasound is often tried first because it’s quicker, cheaper, and lets the clinician move your foot in real time during the scan.
Non-Surgical Treatment
Most people start with conservative measures, and a significant number find enough relief to avoid surgery. The core strategy is reducing pressure on the nerve.
Switching to wider, lower-heeled shoes with a roomy toe box is the simplest first step. On top of that, a metatarsal pad placed just behind (not under) the metatarsal heads can spread the bones apart and take pressure off the nerve. Research shows these pads reduce peak forefoot pressures and redistribute weight more evenly across the sole. One study found that 41% of patients treated with appropriate footwear, orthotics, and soft metatarsal pads had significant improvement without any invasive treatment. Custom orthotics can add arch support and correct alignment issues like flat feet, which helps some people further.
That said, pads and shoe changes alone resolve symptoms in only about 32% of cases over an average of 4.5 months. When they’re not enough, corticosteroid injections are a common next step. A steroid injection delivers anti-inflammatory medication directly around the nerve. The relief can be substantial, but it doesn’t always last. In one study that followed patients for an average of nearly five years, the original injection remained effective for only 36% of them. The rest needed additional injections or eventually opted for surgery. About 44% of patients who initially received injections went on to have the neuroma surgically removed.
When Surgery Becomes the Option
If conservative treatment fails after several months, surgery is typically considered. The most common procedure is a neurectomy, which removes the affected segment of nerve. It’s usually done as a day surgery, meaning you go home the same day.
Afterward, you can put weight on the foot right away using a surgical sandal and crutches. The foot starts returning to normal between four and six weeks, at which point most people can wear trainers or flat, loose-fitting shoes again. Desk workers can often return to their jobs in that same four-to-six-week window, while those with physically demanding jobs may need a bit longer. High-impact exercise should wait at least six weeks, with a gradual return based on comfort.
Because the surgery removes a section of nerve, some permanent numbness between the affected toes is expected. It’s typically a small, well-defined patch and most people find it easy to live with. A less common complication is a stump neuroma, where the cut end of the nerve develops its own painful thickening. This can require additional treatment if it occurs, but it’s not the norm.
What to Expect Long Term
Morton’s neuroma is not dangerous, but it can be persistent. Catching it early and making footwear changes gives you the best chance of managing it without injections or surgery. If you do need surgery, most people return to full activity within a few months. The key variable is how long you’ve had symptoms before treatment. A nerve that’s been compressed for years tends to be more thickened and harder to treat conservatively than one caught within the first few months of pain.