Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Morton’s neuroma — a perineural fibrosis of a common digital nerve of the foot, most commonly in the third interspace (between the third and fourth metatarsal heads) followed by the second interspace — is one of the most common causes of forefoot pain in middle-aged adults, particularly women wearing narrow or high-heeled footwear. Despite the name, it is not a true neuroma but rather a reactive fibrosis around the nerve from chronic compression and friction — producing the characteristic burning, electric, or numb forefoot pain that radiates into the toes and is classically relieved by removing the shoe and rubbing the foot.
Diagnosis
Clinical examination: the Mulder’s click — simultaneous lateral compression of the metatarsal heads with one hand while applying direct pressure in the interspace with the other produces a palpable and sometimes audible click as the thickened nerve is forced between the metatarsal heads; tenderness in the interspace (not on the metatarsal head, as in metatarsalgia); reproduction of the patient’s burning and radiating toe pain with interspace palpation. Web space sensation: reduced sensation in the cleft between the affected toes in advanced cases. Imaging: ultrasound (the preferred imaging modality — identifies the hypoechoic interspace mass and guides injection; neuroma must be >5mm for reliable identification; also identifies bursitis and other interspace pathology); MRI for atypical presentations or surgical planning. Differential diagnosis: Freiberg’s disease (articular pathology vs. interspace mass), plantar plate tear (MTP joint laxity), metatarsalgia (diffuse pain without neuritic quality), intermetatarsal bursitis (communicating bursa — treated identically to neuroma with injection).
Treatment
Conservative: wide toe box footwear; metatarsal pad proximal to the neuroma (distributes metatarsal head pressure); custom orthotics; anti-inflammatory medications. Injection therapy: corticosteroid injection into the interspace under ultrasound guidance — 70–80% response rate for initial injection; typically 2–3 injections separated by 6 weeks if the first provides relief; alcohol sclerosing injection series (4% alcohol every 7–10 days for 7 treatments) — 60–80% success in some series; less systemic side effects than repeated steroids. Surgical excision: for neuroma pain refractory to 6 months of conservative management; dorsal or plantar approach — plantar approach provides better visualization but risks painful plantar scar; excision of the nerve proximal to the bifurcation produces predictable numbness in the web space; 80–85% satisfactory results; residual stump neuromas occur in 5–10%. Dr. Biernacki at Balance Foot & Ankle diagnoses Morton’s neuroma with clinical examination and ultrasound, and provides ultrasound-guided injection therapy before considering surgical excision. Call (810) 206-1402 at our Bloomfield Hills or Howell office for forefoot pain evaluation.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
Frequently Asked Questions
What does Morton’s neuroma feel like?
Morton’s neuroma typically causes a burning, stinging, or electric-shock sensation in the ball of the foot, often radiating to the 3rd and 4th toes. Many patients describe the sensation of stepping on a pebble or having a bunched-up sock underfoot.
Can Morton’s neuroma go away on its own?
Very early-stage neuromas may improve with footwear changes alone. However, established neuromas typically require treatment — padding, orthotics, cortisone injections, or alcohol sclerosing injections. About 20–30% eventually need surgical excision.
What is the success rate of Morton’s neuroma surgery?
Neuroma excision has a 75–85% success rate for long-term pain relief. The risk of permanent numbness in the affected toes should be discussed before surgery. Minimally invasive approaches have similar outcomes with faster recovery.
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Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.
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Morton’s Neuroma Treatment in Howell & Bloomfield Hills
Ball-of-foot pain and toe numbness from Morton’s neuroma can be effectively treated with corticosteroid injections, alcohol sclerosing injections, custom orthotics, or minimally invasive neurectomy when conservative care fails.
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Clinical References
- Pace A, Scammell B, Dhar S. The outcome of Morton’s neurectomy in the treatment of metatarsalgia. Int Orthop. 2010;34(4):511-515.
- Thomson CE, Gibson JNA, Martin D. Interventions for the treatment of Morton’s neuroma. Cochrane Database Syst Rev. 2004;(3):CD003118.
- Mulder JD. The causative mechanism in Morton’s metatarsalgia. J Bone Joint Surg Br. 1951;33-B(1):94-95.
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Howell, MI 48843
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Book Your AppointmentDr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon 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 reached over one million views.
Frequently Asked Questions
Why does the ball of my foot hurt when I walk?
When should I see a doctor for ball of foot pain?
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)
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