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

What Is Morton’s Neuroma?

Morton’s neuroma is a painful condition affecting the interdigital nerve — most commonly between the third and fourth toes — as it passes under the transverse metatarsal ligament. Repetitive compression and irritation of the nerve cause it to thicken and develop fibrous tissue (a neuroma), producing characteristic burning, electric, or tingling pain at the ball of the foot that often radiates into the adjacent toes. The sensation of walking on a pebble or marble is a classic description.

Morton’s neuroma is significantly more common in women — the 8:1 female-to-male ratio reflects the role of narrow, high-heeled footwear in compressing the forefoot and irritating the nerve. Athletic activities requiring forefoot pressure also contribute.

Conservative Treatment: Footwear and Padding

The first intervention is always footwear modification. Transitioning to shoes with a wide toe box, low heel, and adequate depth immediately reduces nerve compression. Many patients experience significant relief within 2–4 weeks of footwear change alone. Metatarsal pads — small dome-shaped pads placed just behind the metatarsal heads — spread the metatarsals apart, relieving pressure on the interdigital nerve. These can be purchased off-the-shelf or built into custom orthotics for a more permanent, precise solution. Custom orthotics addressing any biomechanical contributors (hyperpronation, splayed forefoot) enhance outcomes.

Corticosteroid Injections for Morton’s Neuroma

When conservative measures provide insufficient relief, corticosteroid injections into the intermetatarsal space reduce nerve inflammation and perineural edema. Injections are performed in-office using a thin needle, guided by anatomical landmarks or ultrasound for precision. Most patients experience 3–6 months of significant relief per injection. A series of 2–3 injections is often administered. Long-term corticosteroid injections carry risks including fat pad atrophy and weakening of surrounding structures, so they are best used as a bridge to definitive treatment rather than an indefinite management strategy.

Sclerosing Alcohol Injections

Dilute alcohol (4%) injected around the neuroma causes progressive chemical destruction of the nerve tissue. A series of 4–7 weekly injections is typically required. Response rates of 60–80% are reported in well-designed studies. This technique offers a non-surgical alternative to neurectomy with fewer complications and faster recovery. It is particularly appropriate for patients who are not surgical candidates or who prefer to avoid surgery.

Surgical Neurectomy: Removing the Neuroma

When conservative and injection-based treatments fail, surgical excision of the neuroma is performed. The procedure removes the affected nerve segment through a dorsal (top of foot) incision. Success rates exceed 75–85% for pain relief. Permanent numbness in the affected toe web space is an expected outcome and is well-tolerated by most patients. A small percentage of patients develop a stump neuroma — regrowth of the nerve into a new, sometimes more painful neuroma — that may require repeat surgery. Recovery involves 2–4 weeks in a surgical shoe followed by return to normal footwear.

Ultrasound-Guided Procedures and Cryoablation

Ultrasound guidance improves injection accuracy for both corticosteroid and alcohol procedures. Cryoablation — using extreme cold to ablate nerve tissue — is an emerging technology that provides non-surgical neurolysis with promising early results. Radiofrequency ablation has also been applied to Morton’s neuroma with moderate success. These newer technologies offer additional options for patients who prefer to avoid surgery or who have failed traditional injections.

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When to See a Podiatrist for Morton Neuroma

Morton neuroma causes sharp, burning pain in the ball of the foot that worsens with walking. At Balance Foot & Ankle, Dr. Tom Biernacki offers ultrasound-guided diagnosis and a full spectrum of treatments from cortisone injections and alcohol sclerosing injections to minimally invasive nerve decompression surgery.

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Clinical References

1. Thomson CE, Gibson JN, Martin D. Interventions for the treatment of Morton neuroma. Cochrane Database Syst Rev. 2004;(3):CD003118.
2. Pace A, Scammell B, Dhar S. The outcome of Morton neuroma surgery in obese patients. Int Orthop. 2010;34(4):511-515.
3. Mahadevan D, Venkatesan M, Bhatt R, et al. Diagnostic accuracy of clinical tests for Morton neuroma compared with ultrasonography. J Foot Ankle Surg. 2015;54(4):549-553.

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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.