What Is Morton’s Neuroma — and Why Does It Cause That Burning?

Morton’s neuroma is a benign perineural fibrosis — a thickening of the tissue surrounding the common digital nerve as it passes between the metatarsal heads, typically between the third and fourth toes (less commonly the second and third). The compressed, thickened nerve produces: a burning or electric sensation between the affected toes; a feeling of “walking on a pebble” or a bunched-up sock; tingling or numbness in the adjacent toes; and sharp forefoot pain that radiates toward the toes. Symptoms are reproducible with wearing tight or narrow shoes and relieved by removing the shoe and massaging the foot. At Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan, Dr. Tom Biernacki, DPM treats Morton’s neuromas conservatively — the majority of patients avoid surgery with a comprehensive non-surgical protocol. Call (810) 206-1402.

Conservative Treatment — Four Steps That Resolve Most Neuromas

Step 1 — Footwear modification: a wide toe box is the single most impactful intervention. The mechanism of neuroma formation is chronic compression of the nerve between tight metatarsal heads — a wide-toed shoe eliminates this compression immediately. Combined with a lower heel height (reducing forefoot load during push-off), footwear change alone resolves 30–40% of neuromas at early stages. Step 2 — Metatarsal pad: a metatarsal dome pad placed immediately behind (proximal to) the symptomatic interspace spreads the metatarsal heads, creating space for the compressed nerve. This is the most biomechanically targeted OTC intervention — many patients experience immediate relief. Step 3 — Custom orthotics: for patients with associated overpronation or metatarsal overload, custom orthotics address the structural cause and incorporate the metatarsal dome correction. Step 4 — Corticosteroid injection: ultrasound-guided injection of the neuroma bursa with corticosteroid and anesthetic provides 50–70% long-term resolution in many cases, particularly when combined with footwear modification.

Corticosteroid Injection — What to Expect

We perform neuroma injections using diagnostic ultrasound guidance — the ultrasound confirms the neuroma’s size and location, and guides the needle precisely into the perineural tissue rather than the nerve itself. The injection contains a combination of corticosteroid (triamcinolone or betamethasone) and long-acting local anesthetic. Most patients experience significant relief within 24–72 hours. A series of 2–3 injections spaced 4–6 weeks apart produces best results. Importantly, the injection treats the inflammatory component of the neuroma — combining it with footwear modification and metatarsal pad addresses the mechanical cause simultaneously. Injections without addressing the compressive cause lead to recurrence.

Alcohol Sclerosing Injections — An Alternative to Surgery

For neuromas that have partially responded to corticosteroid injections but not fully resolved, alcohol sclerosing therapy is a series of 4–7 ultrasound-guided injections of 4% ethanol solution that gradually destroys the nerve tissue of the neuroma. Success rates of 70–80% have been reported in published series, with patients avoiding surgery. We offer this protocol at Balance Foot & Ankle — it represents an intermediate option between corticosteroid injections and surgical neurectomy. The injections are performed at weekly intervals with cumulative improvement through the course.

When Is Surgery Required for Morton’s Neuroma?

Surgical neurectomy (removal of the neuroma) is reserved for: failure of comprehensive conservative management over 6+ months including footwear modification, metatarsal padding, and 2–3 injection cycles; neuromas >7–8mm on ultrasound (larger neuromas have lower injection success rates); or patient preference after being fully informed of conservative vs. surgical options. The procedure is performed as outpatient surgery under regional ankle block. The neuroma and a small segment of the nerve are excised through a dorsal (top of foot) incision. Success rate: 85–90% for pain resolution. Potential side effect: permanent numbness in the adjacent toes from the excised nerve — most patients tolerate this well, but patients should be counseled pre-operatively.

The Most Common Morton’s Neuroma Mistake

The most common mistake: wearing tight, pointed dress shoes or high heels to work every day while treating the neuroma conservatively. Conservative treatment cannot overcome the ongoing compressive damage of ill-fitting footwear. If tight shoes are required for work, a metatarsal pad must be used inside those shoes at minimum, and wide footwear adopted for all other hours of the day. The second most common mistake: receiving a single cortisone injection without accompanying footwear modification — the neuroma returns within weeks as the same compressive mechanism re-activates.

Morton’s Neuroma Treatment in Howell & Bloomfield Hills Michigan

Dr. Tom Biernacki, DPM provides comprehensive neuroma evaluation including in-office diagnostic ultrasound for neuroma sizing and injection guidance at Balance Foot & Ankle — serving Howell, Brighton, Bloomfield Hills, Troy, Auburn Hills, West Bloomfield, and all Southeast Michigan. Book your evaluation or call (810) 206-1402.

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.