Morton’s Neuroma Surgery: When It’s Needed and What to Expect in Michigan

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

When Does Morton’s Neuroma Require Surgery?

Morton’s neuroma — a thickening of the nerve tissue between the 3rd and 4th (most commonly) or 2nd and 3rd metatarsals — often responds to conservative treatment. Wide-toe-box shoes, metatarsal pads, custom orthotics, and corticosteroid injections resolve symptoms in approximately 60–80% of patients. Surgery is considered when: symptoms persist beyond 3–6 months despite conservative care; two or more corticosteroid injections have failed; the neuroma is large (greater than 5–6 mm on ultrasound); symptoms significantly interfere with walking or daily activities; or sclerosing alcohol injections (if offered) have failed. Most Michigan patients who reach the surgical threshold have been symptomatic for 6–18 months before surgery.

Types of Morton’s Neuroma Surgery

Neurectomy (nerve excision): The most commonly performed procedure — the enlarged neuroma segment is resected and removed. Approaches: dorsal incision (between the metatarsals from the top of the foot — faster healing, less scar contact with the ground) or plantar incision (from the bottom of the foot — allows direct visualization but weight-bearing scar may cause prolonged tenderness). Dr. Biernacki uses the dorsal approach for most neurectomies. Neurectomy has excellent pain relief rates (80–90% significant improvement) but involves a small risk of recurrence (stump neuroma, 10–15% at 10 years). Decompression (nerve release): Releasing the deep transverse intermetatarsal ligament above the nerve to relieve entrapment without removing the nerve. Preserves nerve function; appropriate for smaller neuromas in earlier-stage disease. Lower success rate than neurectomy for large, well-established neuromas.

Morton’s Neuroma Surgery Recovery

Dorsal neurectomy (most common): Weight-bearing in a surgical boot on the day of surgery; return to athletic shoe at 3–4 weeks; return to running and impact sports at 6–8 weeks. Plantar neurectomy: Non-weight-bearing for 2–3 weeks to protect the plantar incision; return to normal shoes at 4–6 weeks; full activity at 8–10 weeks. Post-operative numbness: Most patients experience permanent numbness in the affected toes (the toes served by the resected nerve). This is expected and typically does not cause functional problems — the sensation of numbness is much preferable to the pre-surgical burning pain. Stump neuroma risk: A small percentage of patients develop a recurrent pain syndrome (stump neuroma) at the proximal cut end of the nerve — 6–12 months post-surgery. This requires evaluation and, if persistent, revision surgical treatment.

Does Insurance Cover Morton’s Neuroma Surgery?

Yes — neurectomy or decompression for Morton’s neuroma is covered by Michigan health insurance when medically necessary. Most insurers require: documented diagnosis (clinical and ultrasound/MRI); failure of conservative treatment for at least 3–6 months including orthotics, shoe modification, and at least one injection; prior authorization. CPT code 28080 (Morton’s neuroma excision) is used for neurectomy billing. Our office obtains prior authorization and handles insurance paperwork. For information on insurance and self-pay costs, see our podiatrist insurance and costs Michigan page.

Schedule Your Morton’s Neuroma Evaluation

Dr. Tom Biernacki evaluates and treats Morton’s neuroma at both Howell and Bloomfield Hills offices. On-site ultrasound guidance is available for diagnostic confirmation and injection treatment. Call (810) 206-1402.

In-Office Treatment at Balance Foot & Ankle

If home care isn’t resolving your Morton’s neuroma, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.

Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.

Frequently Asked Questions

Dr. Tom Biernacki, DPM is a board-certified podiatric surgeon at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan. He performs Morton’s neuroma excision (neurectomy) and nerve decompression with ultrasound-guided injection treatment as an alternative to surgery.

Differential Diagnosis: What Else Could It Be?

Several conditions share symptoms with Morton’s Neuroma and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:

• Capsulitis (2nd MTP). Pain at 2nd-toe base rather than between toes; drawer test positive.
• Stress fracture. Single-point tenderness over a metatarsal shaft, not between toes.
• Freiberg’s infraction. AVN of metatarsal head, classic radiograph flattening.

If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.

Most Common Mistake We See

The most common mistake we see is: Adding a cushioned insole instead of a metatarsal pad. Fix: place the metatarsal pad PROXIMAL to (behind) the metatarsal heads — not directly under them.

Warning Signs That Need Same-Day Care

Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)

If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.

Frequently Asked Questions

What does a Morton’s neuroma feel like?

Patients most often describe it as walking on a pebble or a bunched-up sock — a burning, aching pressure between the third and fourth toes. Some feel an electric shock-like sensation that radiates into the adjacent toes. The pain typically worsens in narrow shoes and improves when barefoot or in wide, low-heeled footwear. This shoe-dependent pattern is the hallmark — if removing your shoes relieves your forefoot pain within minutes, a neuroma is the most likely diagnosis.

What causes a Morton’s neuroma?

A neuroma forms when the digital nerve running between the metatarsals becomes compressed and irritated, leading to perineural fibrosis (scar tissue thickening around the nerve). Common causes: narrow footwear that compresses the forefoot, high heels that shift body weight to the metatarsals, foot deformities (bunions, hammer toes, flat feet) that alter metatarsal spacing, and high-impact repetitive activity. Women develop neuromas 8–10 times more often than men, largely due to footwear choices.

Can a Morton’s neuroma go away without treatment?

Mild neuromas occasionally resolve with footwear changes alone — switching to wide, low-heeled shoes removes the compression causing symptoms. However, once a neuroma has been symptomatic for 6+ months, the nerve thickening is usually permanent without active intervention. Conservative treatment (footwear, metatarsal pads, steroid injections) resolves symptoms in 50–70% of patients. Surgery (neurectomy) has a 75–85% success rate for cases that don’t respond to conservative care.

Does a Morton’s neuroma require surgery?

Only when conservative options have failed. The escalation: wide-toe-box shoes + metatarsal pads → corticosteroid injection (works in 40–60%) → ultrasound-guided alcohol sclerosing injections (70–80% success) → surgical neurectomy. Surgery involves removing the thickened nerve segment under local anesthesia with a short recovery (2–4 weeks). The trade-off: permanent numbness in the web space between the affected toes. Most patients consider this acceptable given significant pain resolution.

How is a Morton’s neuroma diagnosed?

Clinical diagnosis is most common — the history and Mulder’s test (side-to-side metatarsal compression that recreates pain or a palpable click) identify the majority of cases. Ultrasound confirms the diagnosis and measures neuroma size — this helps predict treatment response; small neuromas (<5mm) respond well to injections, large ones (>8mm) often need surgery. MRI is reserved for atypical cases where a ganglion cyst, bursitis, or stress fracture may be mimicking a neuroma.

Can I run with a Morton’s neuroma?

Often yes, with the right footwear. Switching to wide-toe-box running shoes (Altra, Hoka with wide forefoot) with a metatarsal pad placed just proximal to the 3rd–4th interspace reduces compression during running. Reduce mileage temporarily. If pain exceeds 4/10 during a run, the nerve is being compressed and stop — continuing through moderate pain causes further fibrosis. Most runners with neuromas can return to full training after 4–8 weeks of proper shoe and pad adjustment.

Can both feet have neuromas at the same time?

Yes — bilateral neuromas occur in about 15–20% of neuroma patients, most commonly in women with a history of prolonged narrow-shoe wear. Multiple neuromas in the same foot (double neuroma) are less common but occur. When both feet are symptomatic, we typically treat the more painful side first to assess response before proceeding to the other foot. The treatment approach is the same bilaterally.

What shoes are best for Morton’s neuroma?

Wide, deep toe box is the top priority — enough room that the metatarsal heads aren’t compressed at all. Low heel (under 1 inch) to minimize forefoot load. Firm, cushioned forefoot. Best performers: Altra Torin, Hoka Bondi (wide toe box version), New Balance 574/993, Brooks Adrenaline wide. The test: you should be able to wiggle all toes freely with the shoe on. If the forefoot feels snug, the shoe is compressing the neuroma.

What is a metatarsal pad and does it help neuromas?

A metatarsal pad placed proximal to (just behind) the 3rd–4th metatarsal heads spreads those metatarsals apart, decompressing the interdigital nerve. It’s one of the most cost-effective interventions — $5–15 for OTC pads, significant relief for 50–60% of patients when placed correctly. Placement is everything: the pad goes behind the metatarsal heads, not under them. We fit them in-office to confirm position. Incorrectly placed pads (under the heads) increase compression and worsen symptoms.

Are corticosteroid injections safe for Morton’s neuroma?

Yes — for short-term pain relief. Ultrasound-guided cortisone injections reduce inflammation and perineural swelling, resolving symptoms in 40–60% of patients for 3–12 months. We limit to 2–3 injections per neuroma; repeated injections can cause fat pad atrophy and skin depigmentation. If 2 injections don’t produce lasting relief, alcohol sclerosing injections (3–5 treatment series, 70–80% success) or surgery is the next step. Injections are office-based, take 5 minutes, and are covered by most insurance plans.