Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
Intermetatarsal neuromas form when a common digital nerve is repeatedly compressed between metatarsal heads — and the specific web space affected is the first clinical clue that directs treatment, because the third web space is ten times more likely to harbor a neuroma than the others. Call (810) 206-1402 — expert podiatric care across Michigan.
An intermetatarsal neuroma — most commonly called a Morton neuroma — is a perineural fibrosis of the common digital nerve in the interspace between the metatarsal heads, most frequently at the third interspace (between the third and fourth metatarsals). Despite the term “neuroma,” it is not a true neoplasm but a reactive fibrosis from repetitive nerve entrapment and compression. Treatment depends on severity, symptom duration, and the degree of nerve enlargement on imaging.
Intermetatarsal Neuroma: Diagnosis Criteria and Imaging
| Diagnostic Test | Finding | Sensitivity / Specificity | Clinical Role |
|---|---|---|---|
| Mulder click sign | Palpable click + pain with lateral metatarsal squeeze | Sensitivity 61-98%; specificity 100% when click + pain | First-line clinical test; high specificity when positive with pain |
| Web space compression test | Reproduction of symptoms with direct web space pressure | Moderate sensitivity; less specific than Mulder | Adjunct to Mulder; useful for confirming interspace location |
| Ultrasound | Hypoechoic fusiform mass in interspace; moves with Mulder maneuver | Sensitivity 90%+; operator-dependent | First choice for imaging — dynamic, inexpensive, guides injection |
| MRI | Hypointense T1, intermediate T2 mass in plantar interspace | Sensitivity 83%; specificity 99% | Useful when ultrasound inconclusive; evaluates adjacent pathology |
| Diagnostic injection | Symptom resolution after local anesthetic to interspace | Diagnostic and predictive of surgical success | Confirms diagnosis; predicts response to surgical excision |
Intermetatarsal Neuroma Treatment Ladder
| Treatment | Mechanism | Success Rate | Notes |
|---|---|---|---|
| Wide toe box shoes + metatarsal pad | Reduces nerve compression; redistributes metatarsal head pressure | 30-40% significant relief | First-line; essential adjunct to all other treatments |
| Corticosteroid injection (ultrasound-guided) | Reduces perineural inflammation and fibrosis swelling | 50-70% at 1 year; decreases with repeat injections | Limit to 2-3 injections; fat pad atrophy risk with excess |
| Alcohol sclerosing injection series | Progressive neural sclerosis; reduces nerve size | 60-80% at series completion (4-7 injections) | Lower recurrence than steroid; requires multiple visits |
| Custom orthotics | Metatarsal pad placement redistributes load; reduces interspace compression | Adjunct — improves outcomes when combined with injection | Precise pad placement critical (proximal to met heads) |
| Surgical excision (neurectomy) | Complete removal of enlarged nerve segment | 75-90% long-term relief | Permanent plantar numbness in web space; last resort after failure of injections |
At Balance Foot & Ankle in Howell and Bloomfield Hills, we perform ultrasound-guided neuroma diagnosis and injection, prescribe custom orthotics with precise metatarsal pad placement, and perform neurectomy when conservative measures have failed. Call (810) 206-1402.
Sale
PowerStep Pinnacle High Arch Orthotic Insoles, Plantar Fasciitis Relief, Supination Heel Pain, Arch Support, PowerStep Insoles for Women and Men, Made in USA (Men’s 10-10.5, Women’s 12)
- High Arch Support: PowerStep supination insoles deliver firm, flexible high arch support plus a deep heel cradle for comfort, stability & motion control, helping align feet, reduce pain, and protect against ball & heel pressure.
- All Day Comfort & Support: PowerStep Pinnacle High shoe inserts for women and men use premium dual layer cushioning to deliver heel to toe comfort and responsive bounce back with every step, without going flat.
- Relieves & Helps Prevent Pain: PowerStep Pinnacle High insoles for supination can help alleviate common foot conditions often linked to supination, including plantar fasciitis, Achilles tendonitis, fat pad atrophy, and Morton’s neuroma.
- No Trimming: PowerStep insoles move easily from shoe to shoe. Inserts are sized by shoe size for footwear with removable factory insoles. Designed for walking, running, work & casual dress shoes; pairs well with best walking shoes for women and men.
- Made in the USA: We stand behind our PowerStep Insoles for women and men. Proudly made in the USA & backed by a 30-day money-back guarantee. HSA & FSA Eligible
American Academy of Orthopaedic Surgeons: Morton’s Neuroma
Ready to Get Relief?
Same-day appointments available in Howell & Bloomfield Hills, MI
4.9★ | 1,123 Reviews | 3,000+ Surgeries
Or call: (810) 206-1402
For a complete clinical overview: Heel Pain Causes & Treatment Guide — every cause of foot and heel pain diagnosed
What causes morning heel pain?
Plantar fasciitis — the fascia tightens overnight and micro-tears with first steps.
When should I see a podiatrist for heel pain?
If heel pain persists more than 2 weeks, limits walking, or follows an injury.
Doctor Answer
What is an intermetatarsal neuroma and how does it differ from Morton’s neuroma?
An intermetatarsal neuroma is essentially another term for Morton’s neuroma — a thickening of the nerve tissue between the metatarsal heads, most commonly in the third interspace. The terms are used interchangeably. I treat them with metatarsal pads, wider footwear, cortisone or alcohol sclerosing injections, and surgical neurectomy for refractory cases. Most patients respond well to conservative care without surgery.
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.