Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
Balance Foot & Ankle offers same-day appointments for urgent foot and ankle conditions across Southeast Michigan — but the most important factor in outcomes isn’t getting seen quickly. Our podiatrists explain what to do in the first 24-48 hours before your appointment that most patients skip entirely. Call (810) 206-1402 — expert podiatric care across Michigan.
| Condition | Location | Pain Quality | Key Test | Distinguishing Feature |
|---|---|---|---|---|
| Morton’s Neuroma (Interdigital) | 3rd web space > 2nd web space | Burning, shooting into toes; worse in tight shoes | Mulder’s click; web space compression | Pain relieved by removing shoe; Mulder’s click pathognomonic |
| Tarsal Tunnel Syndrome | Medial ankle; tibial nerve under flexor retinaculum | Burning, tingling, numbness into plantar foot and toes | Tinel’s at tarsal tunnel; positive tourniquet test | Medial ankle tenderness; may radiate proximally |
| Baxter’s Nerve Entrapment | First branch inferior calcaneal nerve; medial heel | Deep medial heel pain; no tingling | Point tenderness at medial calcaneal tubercle; abductor digiti quinti weakness | Often misdiagnosed as plantar fasciitis; no arch pain |
| Superficial Peroneal Nerve Neuritis | Dorsum of foot / ankle | Burning; shooting into dorsal toes | Tinel’s at ankle; pressure over extensor retinaculum | Worse with shoe lace pressure; may follow ankle sprain |
| Sural Nerve Entrapment | Lateral ankle / 5th toe border | Burning; lateral foot; shooting to 5th toe | Tinel’s lateral ankle; lateral foot numbness | History of lateral ankle sprain or peroneal surgery |
| Diabetic Peripheral Neuropathy | Diffuse; stocking-glove pattern; bilateral | Burning, numbness, tingling; worse at night | Monofilament (5.07 = 10g); vibration; reflexes | Bilateral; diffuse; loss of protective sensation |
| Treatment | Target Condition | Mechanism | Success Rate | Notes |
|---|---|---|---|---|
| Wide Toe Box + Metatarsal Pad | Morton’s neuroma; metatarsalgia | Decompresses interdigital space; reduces MT head pressure | 40–55% adequate relief | First-line; combined with all other treatments |
| Corticosteroid Injection | Morton’s neuroma; tarsal tunnel; interdigital neuritis | Anti-inflammatory; reduces perineural swelling | 55–70% short-term; 30–40% durable | Limit 2–3 injections; fat pad atrophy risk |
| Alcohol Sclerosing Injection (4%) | Morton’s neuroma | Progressive perineural fibrosis; nerve ablation | 60–80% after 4–7 sessions | Ultrasound-guided; emerging; avoids surgery |
| Surgical Decompression (tarsal tunnel) | Tarsal tunnel syndrome; Baxter’s nerve | Release flexor retinaculum ± abductor hallucis fascia | 70–85% relief when nerve is truly compressed | Best results when specific compression confirmed by EMG/NCS |
| Neurectomy (Morton’s) | Failed conservative + 2 injections | Resect nerve proximal to bifurcation; 3–4 cm resection | 75–85% pain relief | Permanent web space numbness; dorsal approach preferred |
| Medications (neuropathic agents) | Diabetic neuropathy; diffuse neuritis | Duloxetine (FDA-approved); gabapentin; pregabalin; topical compounding | 30–50% pain reduction | Address underlying glycemic control first |
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Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer:
Quick Answer: Nerve pain in the foot arises from multiple distinct pathologies requiring specific diagnosis: Morton’s neuroma (perineural fibrosis at the interdigital nerve, most common at 3rd web space), interdigital neuritis (interdigital nerve inflammation without mass), plantar fascia-nerve entrapment, Baxter’s nerve entrapment (first branch of lateral plantar nerve), and peripheral neuropathy (systemic). Accurate diagnosis drives treatment: shoe modification and metatarsal pad for neuroma; cortisone or alcohol sclerosing injections for symptomatic neuroma; surgical neurectomy or nerve decompression for refractory cases.
Nerve pain in the foot — burning, shooting, or electric pain in the forefoot, toes, or plantar surface — is one of the most frequently misdiagnosed foot complaints. The pain pattern is characteristic: worsening in tight shoes, aggravated by walking on hard surfaces, often relieved by removing the shoe and rubbing the foot. But the specific diagnosis — whether the patient has Morton’s neuroma, interdigital neuritis, Baxter’s nerve entrapment, plantar fascia-nerve impingement, or peripheral neuropathy — determines treatment. At Balance Foot & Ankle PLLC, Dr. Tom Biernacki provides precise nerve pain diagnosis and targeted treatment for Michigan patients.
Morton’s Neuroma vs. Interdigital Neuritis
Morton’s neuroma is perineural fibrosis — an enlargement of fibrous tissue surrounding the interdigital nerve, most commonly at the 3rd web space (between 3rd and 4th toes). The Mulder’s click test (squeezing the forefoot mediolaterally while pressing on the web space) produces a palpable or audible click with pain radiation into the toes. Ultrasound confirms the hypoechoic mass and guides injection. Interdigital neuritis is interdigital nerve inflammation without significant fibrotic mass — produces similar symptoms but smaller lesions on ultrasound, typically responding better to conservative measures. The distinction guides treatment intensity — cortisone injection is effective for both; alcohol sclerosing series and surgical neurectomy are more often required for true neuroma with mass.
Baxter’s Nerve Entrapment
Baxter’s nerve (the first branch of the lateral plantar nerve) is entrapped between the abductor hallucis muscle and the medial plantar fascia — causing heel pain that mimics plantar fasciitis but is localized to the inferomedial heel with radiation into the plantar foot. It is present in up to 20% of chronic heel pain cases. MRI shows edema in the abductor digiti minimi (the intrinsic muscle innervated by Baxter’s nerve). Surgical decompression is highly effective when conservative measures fail.
Treatment Options
Metatarsal padding: Placing a metatarsal pad proximal to the nerve compresses the metatarsal heads together, relieving interdigital pressure on the nerve — effective for mild neuroma and neuritis. Wide toe box footwear: Reduces interdigital compression from shoe last pressure. Cortisone injection: Anti-inflammatory injection into the interdigital space provides temporary-to-moderate relief — useful diagnostically and therapeutically. Alcohol sclerosing series: 3-7 dilute alcohol injections progressively damage the nerve, reducing pain signals — effective in 70-80% of neuroma cases avoiding surgery. Surgical neurectomy: Excision of the neuroma through a dorsal incision — produces definitive relief but creates permanent plantar numbness in the involved toes. Reserved for refractory cases.
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Dr. Tom says: “My podiatrist recommended metatarsal pads for my Morton’s neuroma and positioning them correctly reduced my burning forefoot pain significantly.”
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Positioning is critical — pad must be placed proximal to the metatarsal heads, not at the pain site
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✅ Pros / Benefits
- Precise ultrasound diagnosis confirms neuroma size and guides injection accuracy
- Alcohol sclerosing series avoids surgery in 70-80% of cases
- Metatarsal padding provides immediate symptom relief for appropriate patients
- Surgical neurectomy produces definitive relief when conservative measures fail
❌ Cons / Risks
- Cortisone injection for neuroma provides temporary relief — not a cure
- Surgical neurectomy creates permanent plantar digital numbness in the resected nerve territory
- Alcohol sclerosing series requires 4-7 weekly office visits
Dr. Tom Biernacki’s Recommendation
Foot nerve pain is one of the most satisfying areas of podiatry because the anatomy is logical and the treatments work. The Mulder’s click on the 3rd web space, confirming on ultrasound, and then precisely injecting the neuroma — it’s accurate, reproducible medicine. My preference is to exhaust the sclerosing alcohol series before recommending neurectomy — because a patient who avoids surgery and loses symptoms is a better outcome than one who undergoes neurectomy and lives with permanent toe numbness.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
What does Morton’s neuroma feel like?
Morton’s neuroma typically causes burning, electric, or shooting pain in the forefoot — often described as ‘walking on a pebble’ or ‘my sock is bunched under my foot.’ Pain radiates into adjacent toes (typically 3rd and 4th in the most common web space). Symptoms worsen in tight, narrow shoes and with prolonged walking — and characteristically improve when you remove your shoe and rub the forefoot. Numbness or tingling in the affected toes is common. The Mulder’s click test — squeezing the forefoot mediolaterally while pressing on the web space — reproduces pain and often produces a palpable click.
Can Morton’s neuroma go away without treatment?
Morton’s neuroma rarely resolves spontaneously — it tends to be a progressive condition that worsens with continued narrow shoe compression and metatarsal loading. However, symptoms can be effectively managed and minimized with wide toe box footwear, metatarsal padding, and activity modification. Many patients achieve sufficient symptom control with conservative measures to avoid surgery indefinitely. True resolution of established perineural fibrosis without intervention is uncommon — the fibrous tissue does not resorb on its own.
What is the difference between Morton’s neuroma and metatarsalgia?
Metatarsalgia is a descriptive term for forefoot pain at the metatarsal heads — it describes a location, not a diagnosis. Morton’s neuroma is a specific diagnosis (perineural fibrosis of the interdigital nerve) that produces burning and electric pain with toe radiation. Metatarsalgia typically causes aching or bruised pressure pain directly under the metatarsal head without significant radiation into toes. Both conditions are aggravated by prolonged standing and walking. They can coexist — metatarsal fat pad atrophy with concurrent interdigital neuritis is common in middle-aged women.
What is alcohol sclerosing injection for neuroma?
Alcohol sclerosing injection is a progressive treatment using dilute dehydrated alcohol (4%) injected into the neuroma under ultrasound guidance — typically in a series of 4-7 weekly injections. Each injection gradually damages the nerve fibers within the neuroma, reducing pain signal transmission. Studies report 70-80% success rates for pain reduction without surgery. The advantage over cortisone: more durable results (not just anti-inflammatory relief). The advantage over neurectomy: no permanent numbness if successful. It is Dr. Biernacki’s preferred treatment for established Morton’s neuroma before recommending surgical excision.
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Frequently Asked Questions
When should I see a doctor?
See a podiatrist if pain persists past 2 weeks, prevents normal activity, or is accompanied by red-flag symptoms (warmth, swelling, numbness, inability to bear weight).
Can I treat this at home?
Mild cases respond to RICE protocol (rest, ice, compression, elevation), supportive shoes, and OTC anti-inflammatories. Persistent symptoms need professional evaluation.
How long does it take to heal?
Most soft tissue injuries resolve in 2-6 weeks with appropriate care. Bone injuries take 6-12 weeks. Chronic conditions need longer-term management.
Ready to get relief? Book an appointment at Balance Foot & Ankle or call (810) 206-1402. Same-day appointments available in Howell & Bloomfield Hills, MI.
In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your metatarsalgia, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
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