Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
The most important clinical decision with Morton’s Neuroma Symptoms: How to Know If You Have One isn’t which treatment to choose — it’s identifying which subtype you have first. Our podiatrists see patients treated for the wrong subtype for months before the correct diagnosis leads to full resolution. Call (810) 206-1402 — expert podiatric care across Michigan.
Morton’s neuroma — a thickening of the tissue around a nerve in the forefoot — causes characteristic symptoms that most patients describe as “walking on a marble” or “a bunched-up sock.” Recognizing these symptoms early leads to more conservative treatment options. Balance Foot & Ankle diagnoses and treats Morton’s neuroma in Howell and Bloomfield Hills, MI.
Morton’s Neuroma Symptoms at a Glance
| Symptom | Description | % of Patients |
|---|---|---|
| “Marble” or “lump” sensation | Feeling of a foreign body or bunched-up sock under the ball of the foot | ~65% |
| Sharp shooting pain into toes | Electric or burning pain radiating into 3rd and 4th toes (most common) or 2nd and 3rd | ~75% |
| Numbness or tingling in toes | Pins-and-needles or reduced sensation in adjacent toes; may be constant | ~60% |
| Pain with narrow shoes or high heels | Compression of forefoot squeezes intermetatarsal space; relieves with shoe removal | ~80% |
| Pain with toe extension | Extending the toes (as in toe-off during walking) compresses nerve | ~50% |
| Relief when barefoot or in wide shoes | Classic — removing narrow shoes provides near-immediate relief | ~70% |
| Mulder’s click | Audible/palpable click when forefoot squeezed laterally while pressing the web space | ~30–50% clinically; pathognomonic when present |
Which Web Space? Typical Locations
| Location | Nerves Affected | Frequency |
|---|---|---|
| 3rd web space (between 3rd and 4th metatarsals) | 3rd common digital nerve | ~75% of neuromas |
| 2nd web space (between 2nd and 3rd metatarsals) | 2nd common digital nerve | ~20% of neuromas |
| 1st or 4th web space | 1st or 4th common digital nerve | ~5%; uncommon |
| Multiple web spaces (bilateral or same foot) | Multiple nerves | ~20% of patients have bilateral; rare same foot |
Morton’s Neuroma vs. Metatarsalgia vs. Capsulitis
| Feature | Morton’s Neuroma | Metatarsalgia | 2nd MTP Capsulitis |
|---|---|---|---|
| Pain character | Sharp, burning, electric; radiates to toes | Aching, dull; under metatarsal heads | Aching at 2nd MTP joint; toe may drift up |
| Numbness/tingling | Common in adjacent toes | Uncommon | Uncommon |
| Location of max tenderness | Web space; between metatarsal heads | Under metatarsal heads | 2nd MTP joint; dorsal or plantar |
| Mulder’s click | Present if neuroma >5mm | Absent | Absent |
| Ultrasound finding | Hypoechoic mass in web space; size in mm | Soft tissue swelling; callus | Joint effusion; plantar plate discontinuity |
| Response to wide shoes | Significant relief | Moderate relief | Moderate relief |
Diagnosis — How Morton’s Neuroma Is Confirmed
- Clinical exam: Mulder’s test (forefoot squeeze + web space pressure), toe web space palpation, toe sensation testing; most neuromas are diagnosed clinically
- Ultrasound: gold standard for size measurement; hypoechoic mass in web space; guides injection; sizes <5mm less reliably visualized
- Diagnostic injection: 1–2mL local anesthetic directly into the web space; if symptoms resolve within 5 minutes → confirms neuroma location
Treatment Progression
- Step 1: Wide, low-heeled shoe with roomy toe box; metatarsal pad placed behind the 3rd and 4th metatarsal heads
- Step 2: Corticosteroid injection (triamcinolone 40mg + local anesthetic) into the web space; 50–80% significant relief; can repeat up to 3 times
- Step 3: Sclerosing alcohol injection series (4% alcohol × 4–7 injections); alternative to surgery for persistent neuromas
- Step 4: Surgical excision or nerve decompression; excision: 85% success rate; small risk of stump neuroma
For Morton’s neuroma diagnosis and ultrasound-guided injection, contact Balance Foot & Ankle in Howell (4330 E Grand River Ave) or Bloomfield Hills (43494 Woodward Ave #208) at (810) 206-1402.
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📋 Dr. Tom Biernacki, DPM, FACFAS answers:
Morton’s neuroma produces a very distinctive sensation that patients almost universally describe the same way: it feels like walking on a pebble or a rolled-up sock that isn’t there, combined with burning, shooting, or electric pain radiating into the third and fourth toes. Many patients also describe a sensation of numbness or ‘going to sleep’ in the affected toes after prolonged standing or walking. The pain is typically localized to the ball of the foot between the third and fourth metatarsal heads and is instantly relieved by removing the shoe and squeezing the forefoot. Wide footwear and low-heeled shoes provide significant relief; narrow, high-heeled shoes cause immediate symptom recurrence. A clinical squeeze test (compressing the metatarsal heads from the sides while pressing up between them) often reproduces the pain and may produce a palpable click (Mulder’s sign).
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 made him one of the most-followed foot & ankle educators on YouTube.