What Is a Morton’s Neuroma and Why Does It Hurt? For specialized treatment, see our neuroma treatment Howell MI.
A Morton’s neuroma is not a true tumor but a benign thickening of the nerve tissue around the interdigital nerve—the nerve that runs between the metatarsal heads and branches to the adjacent toes. The most commonly affected interspace is between the third and fourth metatarsals (third interspace), though second-space neuromas also occur. Repetitive compression of the nerve between the metatarsal heads leads to perineural fibrosis (scar tissue formation around the nerve), thickening, and characteristic burning, shooting, or electric pain in the ball of the foot that radiates to the adjacent toes.
The classic presentation: burning, tingling, or electric pain in the ball of the foot between the third and fourth toes, worse with tight shoes or high heels, often improved by removing the shoe and rubbing the foot. Some patients describe the sensation of “walking on a pebble” or “a rolled-up sock” under the forefoot. The interdigital nerve is compressed between the metatarsal heads with each step—tight shoes, high heels, and activities with toe extension all aggravate symptoms by squeezing the interspace further.
Conservative Treatment: First-Line Approaches
Footwear Modification
Changing shoes is the most important first step in neuroma treatment. Wide toe box shoes—that do not compress the metatarsal heads—immediately reduce interspace pressure and often provide significant relief. High heels increase forefoot loading and metatarsal head compression dramatically; avoiding heels is essential during treatment. Look for shoes labeled “wide” or “extra wide” width, with a soft, flexible forefoot and adequate toe room. Many patients find that footwear modification alone provides sufficient relief for mild neuromas. For runners, switching to a wider shoe or a model with a broader forefoot can reduce neuroma flares.
Orthotics and Metatarsal Pads
A metatarsal pad placed just proximal to (behind) the metatarsal heads in the shoe spreads the metatarsal heads apart by elevating and separating them, reducing compression of the interdigital nerve. This is a simple, inexpensive, and effective intervention—self-adhesive metatarsal pads cost $10–$20 and provide immediate relief in many patients. Placement is critical: the pad must be behind (proximal to) the metatarsal heads, not under them. Custom orthotics with an intrinsic metatarsal pad incorporated into the orthotic body provide more precise and durable metatarsal splaying than adhesive pads.
Corticosteroid Injection
Corticosteroid injection into the affected interspace is the most effective single conservative treatment for Morton’s neuroma. A local anesthetic and corticosteroid are injected directly into the symptomatic interspace under ultrasound guidance for precision. Short-term relief (3–6 months) is achieved in approximately 70–80% of patients with injection. Multiple injections (2–3 over 3–6 months) are often performed for recurrence. Long-term resolution after injection series occurs in approximately 50–60% of patients. Risks of repeated injections include fat pad atrophy and plantar skin thinning—typically a limit of 3–4 injections per site is observed.
Alcohol Sclerosing Injections
Ultrasound-guided injection of dilute alcohol (4%) into the neuroma—performed as a series of 3–7 injections at weekly or biweekly intervals—chemically scleroses (destroys) the nerve tissue, permanently reducing or eliminating pain in many cases. Studies report 70–80% good-to-excellent results with alcohol sclerosing injection series. This approach offers the potential for permanent relief without surgery. It is less commonly performed than corticosteroid injection but represents an important option between injection therapy and surgical neurectomy.
Surgical Treatment: Neurectomy
When conservative measures have failed after 3–6 months, surgical neurectomy (removal of the affected interdigital nerve) is highly effective. The procedure removes the thickened portion of the interdigital nerve through a dorsal (top of foot) incision between the metatarsals. It is performed as an outpatient procedure under local or regional anesthesia, taking approximately 30–45 minutes. Recovery allows immediate weight-bearing in a surgical shoe; return to normal footwear typically occurs at 3–4 weeks.
Success rates for Morton’s neuroma surgery are approximately 80–85% good-to-excellent outcomes, with significant or complete pain relief. The trade-off is permanent numbness in the web space between the affected toes—the nerve that caused the pain is removed. Most patients consider this an acceptable trade-off for pain relief, and the numbness rarely causes functional problems. A plantar approach (incision on the bottom of the foot) is an alternative technique with slightly higher success rates but requires non-weight-bearing during healing. The choice of approach is surgeon-dependent.
Frequently Asked Questions
Can a Morton’s neuroma go away on its own?
Small, early neuromas can sometimes improve significantly or resolve with footwear modification—wider shoes and avoiding heels—if the compressive cause is eliminated before significant perineural fibrosis develops. In early-stage neuromas, removing the aggravating factor (tight shoes, high heels, high-impact activities) combined with a metatarsal pad can allow the inflammation to settle. However, established neuromas with significant fibrosis do not resolve spontaneously—the scar tissue around the nerve is permanent and symptoms typically progress without treatment. Most patients with symptomatic Morton’s neuroma require some form of active treatment (injection, orthotics with metatarsal pad, or surgery) for meaningful relief.
Is Morton’s neuroma surgery worth it?
Morton’s neuroma surgery is worth it for patients who have failed 3–6 months of conservative management (footwear changes, orthotics, injections) and have significant symptoms affecting daily activity and quality of life. With 80–85% success rates and a relatively quick recovery, neurectomy is one of the more reliable foot surgeries. The permanent numbness in the web space between the toes is the main downside—most patients find this much preferable to ongoing nerve pain. Surgery is less appropriate as an initial treatment—conservative measures should be tried first, as a meaningful percentage of patients achieve adequate long-term relief without surgery.
How many corticosteroid injections can I have for a neuroma?
Most podiatrists recommend limiting corticosteroid injections to a maximum of 3–4 injections per interspace to avoid fat pad atrophy and plantar skin changes from repeated steroid exposure. Injections are typically spaced 4–8 weeks apart. If a patient has had 2–3 injections with good but temporary relief, alcohol sclerosing injection series or surgical neurectomy are appropriate next steps for more durable resolution. Continuing to repeat corticosteroid injections indefinitely is not recommended once the maximum is reached. If you’ve had multiple injections with good relief each time but recurrence, discuss alcohol sclerosing injections or neurectomy with your podiatrist as more permanent options.
Medical References & Sources
- American Orthopaedic Foot & Ankle Society — Morton’s Neuroma
- PubMed Research — Morton’s Neuroma Injection Treatment Outcomes
- PubMed Research — Morton’s Neuroma Surgical Neurectomy Outcomes
Dr. Tom Biernacki, DPM is a board-certified podiatric surgeon at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan. He treats Morton’s neuroma with corticosteroid injection, alcohol sclerosing injection series, custom orthotics with metatarsal pads, and surgical neurectomy for refractory cases.
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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.