Morton’s neuroma is a painful thickening of the nerve tissue between the third and fourth toes, causing burning, shooting, or electric-shock pain in the ball of the foot. It is one of the most commonly misdiagnosed causes of forefoot pain — and one of the most treatable when caught accurately. At Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan, Dr. Tom Biernacki, DPM diagnoses and treats Morton’s neuroma without unnecessary surgery in the majority of cases.

Quick Answer: What Is Morton’s Neuroma?

Morton’s neuroma is a benign thickening of the interdigital nerve between the third and fourth toes, caused by repetitive compression and irritation. It produces burning, shooting, or numbness in the ball of the foot and toes — often described as “walking on a pebble” or an electric shock between toes 3 and 4. Most cases respond to wider toe box shoes, metatarsal pads, corticosteroid injections, or sclerosing alcohol injections without surgery. See a podiatrist if burning or numbness has lasted more than 4 weeks or is worsening.

Morton’s Neuroma Symptoms: What to Look For

The hallmark symptom of Morton’s neuroma is a burning, electric, or shooting pain at the ball of the foot, typically between the third and fourth toes. Patients often describe the sensation as “walking on a pebble” that disappears when they remove their shoe and massage the forefoot. Symptoms typically worsen with tight shoes, high heels, or prolonged standing, and may include tingling or numbness spreading into the affected toes.

• Burning or electric shock pain between 3rd and 4th toes
• “Pebble in the shoe” sensation at the ball of the foot
• Tingling or numbness in the toes
• Pain that worsens in narrow shoes or high heels
• Relief when shoes are removed and area is massaged
• A palpable “click” between metatarsal heads (Mulder’s click) — diagnostic on examination

What Causes Morton’s Neuroma?

Morton’s neuroma develops from repetitive irritation and compression of the interdigital nerve where it passes between the 3rd and 4th metatarsal heads. The nerve becomes compressed during toe push-off, causing inflammation and eventual fibrous thickening around the nerve sheath. Contributing factors include narrow or tight toe boxes, high heel shoes (which load the forefoot), high-impact activities (running, aerobics), and biomechanical factors like flat feet or bunions that alter forefoot pressure distribution.

In our clinic, women present with Morton’s neuroma approximately three to four times more often than men — a direct reflection of narrow toe box and high heel shoe use. The 3rd webspace is involved in over 80% of true neuromas; involvement of the 1st or 2nd webspace is uncommon and suggests alternative diagnoses.

How Is Morton’s Neuroma Diagnosed?

Diagnosis begins with clinical examination — specifically Mulder’s click test, where the examiner compresses the metatarsal heads laterally while palpating the affected webspace. A palpable click with reproduction of symptoms is highly specific for neuroma. Diagnostic ultrasound is the preferred imaging study, allowing real-time visualization of the neuroma and assessment of its size, which guides treatment decisions. MRI can confirm the diagnosis when ultrasound is inconclusive. X-rays are typically normal but are obtained to exclude stress fracture and metatarsalgia.

Differential Diagnosis: Other Causes of Ball-of-Foot Pain

Several conditions mimic Morton’s neuroma and must be excluded before treatment begins. Accurate diagnosis is essential because the treatments differ significantly.

• Metatarsalgia — Diffuse forefoot pain at the metatarsal heads; responds to metatarsal pads; no burning/electric quality
• Metatarsal stress fracture — Point tenderness over a single metatarsal shaft; positive bone scan or MRI; no neurological symptoms
• Freiberg’s infraction — Avascular necrosis of 2nd metatarsal head; adolescents and young adults; visible on X-ray in later stages
• Intermetatarsal bursitis — Fluid-filled sac between metatarsal heads; often coexists with neuroma; visible on ultrasound
• Capsulitis / plantar plate tear — 2nd MTP joint pain; vertical toe instability test positive; different pain quality
• Tarsal tunnel syndrome — Burning from ankle to all toes; Tinel’s at medial ankle; systemic cause (thyroid, diabetes)

Morton’s Neuroma Treatment: Conservative Options First

The vast majority of Morton’s neuromas respond to conservative treatment when addressed early. The goal is to reduce compression and inflammation at the affected interdigital nerve. In our clinic, approximately 75% of patients avoid surgery with appropriate conservative care.

• Footwear modification — Wide toe box shoes reduce lateral compression; flat or low-heeled shoes reduce forefoot load; this is the single highest-yield intervention
• Metatarsal pad — A small pad placed just proximal to the metatarsal heads spreads them apart and reduces nerve compression; must be placed behind (proximal to) the metatarsal heads to be effective
• Custom orthotics — Provide metatarsal relief and correct biomechanical contributors (flat feet, overpronation); covered by most insurance plans when medically indicated
• Corticosteroid injection — Ultrasound-guided injection reduces perineur inflammation; effective for 6–12 months in many cases; up to 3 injections may be appropriate
• Sclerosing alcohol injection series — 4% alcohol solution injected at biweekly intervals; destroys the neuroma tissue; effective in 60–80% of cases; avoids surgery and preserves sensation
• PRP injection — Emerging regenerative option for chronic neuromas; reduces inflammation through growth factor delivery

Morton’s Neuroma Surgery: When Is It Needed?

Surgery is considered when conservative treatment including at least two corticosteroid or sclerosing alcohol injections has failed after 6 months. The two surgical options are neurectomy (excision of the neuroma) and nerve decompression. Neurectomy removes the thickened nerve segment entirely and is the most common approach; success rates are 80–90%, but permanent numbness in the affected toes should be expected. Nerve decompression releases the intermetatarsal ligament to relieve compression without removing the nerve; less common but preserves sensation.

The most common mistake before surgery: patients who have had one cortisone injection that provided temporary relief decline a second injection, then proceed to surgery — which carries more risk and recovery time than a second injection course. Corticosteroid and alcohol injection series deserve at least two full cycles before surgical referral.

Warning Signs: When to See a Podiatrist Promptly

• Burning or numbness lasting more than 4 weeks despite footwear changes
• Symptoms spreading beyond the 3rd–4th webspace into multiple toes
• Symptoms in both feet simultaneously (may indicate systemic neuropathy)
• Diabetic patient with new forefoot burning — urgent evaluation to exclude Charcot or neuropathic change
• Rapidly progressive numbness — potential nerve compression elsewhere in the chain

Morton’s Neuroma Treatment in Michigan: Howell & Bloomfield Hills

Dr. Tom Biernacki, DPM at Balance Foot & Ankle provides diagnostic ultrasound, ultrasound-guided corticosteroid and sclerosing alcohol injections, custom orthotic fabrication, and surgical consultation for Morton’s neuroma patients throughout Livingston County, Oakland County, and the greater Detroit Metro area. Same-day appointments available — call (810) 206-1402 or book online.

Related Guides

• Sesamoiditis — Ball of Foot Under Big Toe
• Custom Orthotics in Michigan
• Cortisone Injections for Foot & Ankle Pain
• PRP Injections for Foot & Ankle
• Stress Fracture of the Foot

Dr. Tom Biernacki, DPM

Dr. 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.