Morton's Neuroma: Diagnosis, Injection Therapy, and

Quick answer: Mortons Neuroma Diagnosis Injection Surgery Guide is a common foot/ankle topic that affects many patients. Effective treatment starts with a targeted diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Hills practices. Call (810) 206-1402.

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Morton’s neuroma is a perineural fibrosis and nerve enlargement of the common digital intermetatarsal nerve — most commonly affecting the third interspace (between the third and fourth metatarsal heads), with second interspace involvement in approximately 20% of cases. The condition produces a characteristic burning, shooting, or electric pain in the forefoot and toes that is relieved by removing shoes and massaging the foot.

Anatomy and Pathogenesis

The common digital nerve enters the intermetatarsal space from the plantar surface and is compressed against the deep transverse intermetatarsal ligament during toe extension and metatarsal head spreading with weight bearing. Repetitive trauma induces perineural fibrosis, epineural thickening, and axonal degeneration — the hallmark histopathological features of Morton’s neuroma. The third interspace is preferentially affected because the third common digital nerve receives contributions from both the medial and lateral plantar nerves, making it larger and more prone to entrapment.

Clinical Diagnosis

The classic presentation is burning forefoot pain radiating into the third and fourth toes (or second and third toes for second interspace neuromas) exacerbated by narrow or high-heeled footwear and prolonged walking. The Mulder’s click test — compressing the metatarsal heads transversely while applying dorsoplantar pressure to the interspace — reproduces the pain with an audible or palpable click in many patients. Diagnostic ultrasound confirms neuroma presence and size, guiding injection placement with high accuracy. MRI is reserved for atypical presentations or when surgical planning requires precise anatomical mapping.

Conservative Management

First-line treatment includes footwear modification (wide toe box, low heel, metatarsal pad placement), custom orthotics with metatarsal pad positioning to offload the affected interspace, and activity modification. Corticosteroid injection with precise placement under ultrasound guidance achieves good short-term symptom relief in 50–70% of patients, with response rates correlating with accurate interspace injection rather than peri-capsular injection. Sclerosing alcohol injection series (4% alcohol solution) achieves meaningful pain reduction in 60–80% of patients in multiple controlled studies and may be preferred for patients wishing to avoid surgical intervention.

Surgical Treatment: Neurectomy vs. Decompression

Surgical neurectomy (excision of the neuroma and proximal nerve stump) is the definitive treatment for Morton’s neuroma failing 3–6 months of conservative care, achieving excellent outcomes in 80–90% of patients. The procedure is performed dorsal or plantar approach under regional anesthesia. Neurectomy requires complete symptom counseling — permanent numbness in the cleft between the involved toes is expected and must be understood before surgery. Nerve decompression (release of the deep transverse intermetatarsal ligament without nerve excision) is an alternative preserving sensation with comparable short-term outcomes, though with higher recurrence rates in some series.

Morton’s Neuroma Care at Balance Foot & Ankle

Dr. Biernacki at Balance Foot & Ankle diagnoses Morton’s neuroma with on-site ultrasound and provides both ultrasound-guided corticosteroid injection and surgical neurectomy within the practice. Custom orthotic accommodation and metatarsal pad fabrication are available at the same visit. Call (810) 206-1402 for a same-week evaluation of forefoot burning pain.

Frequently Asked Questions

When should I see a podiatrist?

If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).

What does treatment cost?

Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.

How quickly can I get an appointment?

Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.

Related Care at Balance Foot & Ankle

Clinical morton services at our Howell and Bloomfield Hills offices.

Mortons NeuromaCortisone InjectionsCustom Orthotics