Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
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Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle
Last reviewed: May 2026
In This Article
- Quick Answer
- Watch: Dr. Tom Biernacki, DPM
- What Is a Morton’s Neuroma and Why Does It Hurt? For specialized treatment, see our neuroma treatment Howell MI.
- Conservative Treatment: First-Line Approaches
- Surgical Treatment: Neurectomy
- In-Office Treatment at Balance Foot & Ankle
- More Podiatrist-Recommended Neuroma Essentials
- Frequently Asked Questions
- Your Board-Certified Podiatrists
- Differential Diagnosis: What Else Could It Be?
- Most Common Mistake We See
- Warning Signs That Need Same-Day Care
- Pros & Cons of Conservative Care for foot care
- Dr. Tom’s Recommended Products for foot care
- Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)
Medically reviewed by Dr. Tom Biernacki, DPM — Board-certified foot & ankle surgeon, 3,000+ surgeries performed. Updated April 2026 with current clinical evidence. This article reflects real practice experience from Balance Foot & Ankle Specialists in Howell and Bloomfield Township, Michigan.
Quick Answer
Morton’s neuroma is a thickening of nerve tissue between the third and fourth toes causing burning pain, numbness, or the sensation of a pebble under the ball of the foot. Wide toe-box shoes with a metatarsal pad resolve 70% of cases; the rest benefit from cortisone or sclerosing injections.
Watch: Dr. Tom Biernacki, DPM
Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Fellow of the American College of Foot and Ankle Surgeons. Updated April 2026.
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 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.
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 Township 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.
More Podiatrist-Recommended Neuroma Essentials
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New Balance 1080 V14 — max forefoot room decompresses the pinched nerve.
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New Balance 990v6 — prevents the forefoot compression that triggers Morton’s neuroma.
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PowerStep Pinnacle — arch support reduces nerve irritation between metatarsals.
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When to See a Podiatrist
A Morton’s neuroma that doesn’t respond to metatarsal pads and wider shoes within 6-8 weeks usually needs a cortisone injection or — for stubborn cases — alcohol sclerosing or nerve decompression. Balance Foot & Ankle diagnoses neuromas with in-office ultrasound and treats them without surgery in most cases. Don’t keep walking on a burning, tingling forefoot — the nerve irritation compounds the longer it’s untreated.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Township
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 Township, Michigan. He treats Morton’s neuroma with corticosteroid injection, alcohol sclerosing injection series, custom orthotics with metatarsal pads, and surgical neurectomy for refractory cases.
Dr. Tom’s Recommended Products for Ball of Foot Pain
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These are products I personally use and recommend to my patients at Balance Foot & Ankle.
- Metatarsal Pads by Footminders (6-Pack) — Adhesive gel pads positioned behind metatarsal heads — offloads Morton’s neuroma compression point
- PowerStep SlimTech 3/4 Length Insoles — Thin 3/4-length insole with metatarsal pad built in — fits dress and narrow shoes where full insoles won’t
- HOKA Bondi 8 — Maximum forefoot cushioning with wide toe box — reduces metatarsal head load with each step
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For women who want comfort without giving up their shoes — Foot Petals cushions work in heels, flats, and sandals.
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Medically Reviewed by: Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists
Recommended Home Products
Our podiatrists recommend these products to support your treatment at home:
Need personalized product recommendations? Schedule a consultation with our board-certified podiatrists.
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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.
In Our Clinic
The classic Morton’s neuroma patient in our clinic is a 40- to 60-year-old woman who describes burning or “walking on a marble” in the 3rd intermetatarsal web space, often worsening in narrow or high-heeled shoes. We confirm with a Mulder’s click test (sometimes supplemented by ultrasound). The first line of treatment is always a metatarsal pad placed PROXIMAL to the neuroma + a wide-toe-box shoe. Many patients improve just from that — we don’t reach for injections or surgery right away. When conservative care fails after 6–12 weeks, a single corticosteroid or alcohol sclerosing injection is our next step.
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
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- Point tenderness on a single metatarsal suggesting stress fracture
- Unable to bear weight
- Progressive numbness up the foot
- Visible deformity or cross-over toe
Call (810) 206-1402 — same-day and next-day appointments at our Howell and Bloomfield Township offices.
Pros & Cons of Conservative Care for foot care
Advantages
- ✓ Conservative care first
- ✓ Same-week appointments
- ✓ Multiple insurance accepted
Considerations
- ✗ Self-treatment can mask issues
- ✗ See a podiatrist if pain >2 weeks
Dr. Tom’s Recommended Products for foot care
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
Footnanny Heel Cream Dr. Tom’s Pick
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Ready to Get Back on Your Feet?
Same-day appointments in Howell + Bloomfield Township. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
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Call Now: (810) 206-1402
About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Township, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
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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.
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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.