Morton's Neuroma

Morton's neuroma is a thickened, irritated nerve in the front of the foot that causes burning pain and tingling around the toes. People often describe it as standing on a folded sock or a pebble. This page explains how it arises, what separates it from other forefoot pain, and how it is treated, including treatment in turkey.

What is Morton's neuroma?

Between each pair of long foot bones (metatarsals) runs a small nerve that carries feeling to two neighbouring toes. In Morton's neuroma, the nerve that serves the third and fourth toes is squeezed again and again under a ligament, and it thickens with scar-like tissue. The nerve itself is not a tumour in the usual sense, although the term neuroma suggests one.

Doctors also call it an interdigital neuroma or plantar digital neuritis. The name Morton comes from the physician who described forefoot pain of this kind in the 19th century.

Who is affected by Morton's neuroma?

It is most often found in adults between 30 and 60 years of age, and women are affected several times more often than men. High heels and tight toe boxes are the usual explanation, since they squeeze the forefoot and push the toes upward. Runners, dancers, and people who kneel or stand for work are also seen often.

Both feet can be affected, but one side usually bothers people first. The second and third toe gap is much less often involved.

How serious is Morton's neuroma?

It is not dangerous and it does not spread, but it can be disabling because the pain stops people from walking, running or wearing normal shoes. Early cases settle with simple steps. Long-standing cases may leave the nerve permanently thickened, which is why persistent pain deserves a proper assessment rather than years of guessing.

The typical complaint is burning pain between the toes, often with the pebble in the shoe feeling that makes people stop and rub the foot. The sections that follow describe what you feel, how doctors confirm it, and which treatments work in which order.

The forefoot is a tight space where nerves, ligaments and bones share very little room, which is why a small nerve can be pinched so easily. Seeing this layout explains the pain pattern.

What is the normal structure of the forefoot?

The ball of the foot is formed by the heads of five metatarsal bones. Between neighbouring heads, a ligament called the deep transverse metatarsal ligament links the bones together like a cord. Just under that ligament, in the gap between the heads, run a common plantar digital nerve and a small artery.

The nerve then splits to supply the sides of two toes. The third space is the one where this nerve is formed from two branches (one from the medial and one from the lateral plantar nerve), so it is thicker and less mobile, and this is thought to be why it is the usual site.

What changes in Morton's neuroma?

When the toes are bent upward, as in a high heel or while pushing off in running, the nerve is pulled up against the sharp edge of the ligament. Repeated pinching leads to swelling around the nerve and then thickening of its protective sheath (fibrosis). The nerve can measure 5 mm or more in diameter on ultrasound, compared with a thin thread when healthy.

A swollen nerve is more sensitive and gets pinched more easily, so a cycle forms. A fluid sac (bursa) beside the nerve may add to the squeeze.

Why is the pain felt in the toes?

The nerve carries touch and pain signals for the facing sides of the third and fourth toes. When it is irritated, the brain reads that signal as burning, buzzing or numbness in those toes, even though the problem sits in the ball of the foot.

Morton's neuroma is described by where it sits and how long it has been present rather than by formal grades. These details guide what treatment is realistic.

Which web space is involved?

Most cases arise in the third web space, between the third and fourth toes, which accounts for the large majority. The second space, between the second and third toes, is the next most common. Occurring in the first or fourth space is rare and makes doctors look harder for another cause. Sometimes two spaces are painful at once, which is worth recognising because the plan may change.

How is the condition staged in practice?

There is no universal staging scale, but surgeons commonly think in three broad phases, as shown below. The phase shows how likely it is that simple measures will be enough.

What is a recurrent or stump neuroma?

After a nerve is cut, the end can form a new tender lump called a stump neuroma. This is a recognised cause of pain that returns after surgery. Recurrent pain usually needs a careful look for the cause, including whether the wrong space was operated on or whether another condition was present all along.

Why does the classification matter?

The earlier the phase, the better non-surgical care is likely to work. In a chronic neuroma, the nerve has often changed permanently, and conservative care may only reduce symptoms. A clear picture of the phase also helps set realistic expectations for any injection or operation.

Morton's neuroma is usually diagnosed from your story and a hands-on examination, with imaging used to confirm the nerve and exclude other causes. A good clinician can often make the diagnosis within one consultation.

What will the doctor ask?

You will be asked where the pain sits, what it feels like, which shoes bring it on and what relieves it. The classic clues are burning in the ball of the foot, tingling in two toes and prompt relief when the shoe is removed. The doctor will also ask about work, sport, heels, and any previous forefoot injury or surgery.

What does the examination find?

The doctor presses between the metatarsal heads from the sole side and checks for sharp tenderness in the web space. In the Mulder test, the forefoot is squeezed from the sides while the web space is pressed, and a click with reproduction of the pain suggests a neuroma. The doctor also checks the toe joints, the arch, the skin sensation and the range of ankle motion, and examines the other foot for comparison.

Is imaging needed?

Imaging is not always required, but it helps. Ultrasound, performed by an experienced operator, shows a rounded, low-signal mass between the metatarsal heads, often 5 mm or more, and can be done at the same visit. MRI is a good alternative and is useful when several spaces are painful or the diagnosis is unclear. Plain X-rays do not show the nerve, yet they are taken to rule out stress fractures, arthritis and bone shape problems.

Can a diagnostic injection help?

Placing a small amount of local anaesthetic into the web space and seeing whether the pain stops for a while is both diagnostic and therapeutic. If the pain disappears, it supports the diagnosis.

What should you prepare for a remote review?

Prepare a short written timeline, a photo of the footwear you wear most often, any ultrasound or MRI reports with the images, and weight-bearing X-rays if you have them. Add notes about previous injections and their effect. Our medical record review guide explains how files are shared and checked.

Most people with Morton's neuroma improve without surgery, and treatment starts with taking pressure off the nerve. The earlier these steps begin, the better they tend to work.

Which footwear changes come first?

Wide-fitting shoes with a roomy toe box are the foundation. Look for a low, broad heel, a firm sole that does not bend at the ball of the foot, and a soft upper. A shoe with a mild rocker sole lets the foot roll through the step without bending the toes. Avoid heels higher than about 4 cm (1.5 inches) and narrow pointed fronts. Many people notice a difference within 2 to 4 weeks.

How do pads and insoles work?

A metatarsal pad is a small dome placed just behind the ball of the foot, not under it. It spreads the metatarsal heads and lifts the load off the nerve. Placement is critical, so a podiatrist or physiotherapist often positions it. Custom or off-the-shelf insoles that support the arch can help if flat feet add to the strain.

Can physiotherapy and activity changes help?

Physiotherapy works on calf flexibility, foot muscle strength and walking or running patterns. Short-term changes such as swapping running for swimming or cycling while the nerve settles are helpful. Avoiding hill work and kneeling positions that load the toes can be enough for early cases. Gentle forefoot massage and toe spreading exercises can relieve symptoms during the day.

Which medicines are used?

Simple pain relievers and anti-inflammatory medicines may take the edge off flare-ups, although they often have limited effect on nerve pain. Some doctors prescribe a nerve pain medicine for a short trial in stubborn cases. Always check with a doctor or pharmacist about suitability.

What does a Morton's neuroma injection do?

A Morton's neuroma injection places a corticosteroid, sometimes with local anaesthetic, into the web space, usually guided by ultrasound. It reduces swelling around the nerve and brings relief for weeks to months in many people, although relief may fade. Doctors usually limit the number of injections, often to 2 or 3, because repeated steroid can thin the fat pad or damage nearby joints and ligaments.

Other injections, such as alcohol sclerosing injections, are used in some centres, and evidence for them is limited.

Which other non-surgical treatments exist?

Radiofrequency ablation and cryotherapy (freezing the nerve) are minimally invasive options that damage the nerve fibres to stop pain signals. They can help people who are not suitable for surgery, but the evidence base is smaller than for standard surgery, so ask about the results the clinic can show.

Surgery for Morton's neuroma is an option when the pain stays disabling after non-surgical treatment, and the operation is short and usually done as a day case. The two main choices are to release the pressure on the nerve or to remove the nerve.

What is neurectomy?

Neurectomy is removal of the thickened section of nerve. The surgeon makes a cut either on the top of the foot (dorsal approach) or on the sole (plantar approach) and takes out the affected nerve segment along with its swelling. The two toes lose feeling on their facing sides, which most people accept in exchange for the burning pain going away. It is the classic operation and gives lasting relief to most patients, although a minority are left with some pain or a stump neuroma.

What is nerve decompression?

In decompression, the surgeon cuts the tight deep transverse metatarsal ligament but leaves the nerve in place. This lets the nerve slide freely and usually keeps feeling in the toes. It can be done through a small incision or by keyhole technique, and it suits people with milder disease and a nerve that is not hugely enlarged. The surgeon may also use it alongside other forefoot procedures.

Where does forefoot surgery come in?

Most foot surgeons plan a neuroma operation within the wider field of forefoot surgery, since a bunion, hammertoe or joint problem can coexist. If you travel for the operation, our forefoot surgery in turkey page describes the pathway, and the forefoot surgery cost guide explains how pricing is shown.

How do the options compare?

What are the usual steps?

The operation takes about 20 to 40 minutes. It is done under a local anaesthetic ankle block with or without sedation, and you usually go home the same day. A bandage and a protective shoe are worn for about 2 weeks. The surgeon also tests the neighbouring spaces and may treat a coexisting problem at the same time.

You cannot always prevent Morton's neuroma, but you can lower the pressure on the forefoot that causes it. Prevention is mostly about footwear, load and foot strength.

Which shoes protect the nerve?

Choose shoes with a wide, deep toe box, a low heel and a sole that is firm enough to stop the front of the foot bending sharply. Fit them while standing, and make sure your toes can spread. If you must wear heels, keep them for short occasions and swap into flat shoes for walking. A heel above 5 cm (2 inches) throws large forces onto the ball of the foot.

How should you manage sport and work?

Runners should increase mileage slowly, replace worn shoes every 500 to 800 km, and vary surfaces. Dancers and climbers, whose sport requires tight shoes or tiptoe positions, can build in rest periods and use a metatarsal pad when allowed. If you kneel or crouch at work, take short breaks to straighten the toes and shake out the feet.

What strengthens the foot?

Strong calves and foot muscles share the load of walking and take pressure off the ball of the foot. The stretching and short-foot exercises in the self-care section are a good routine. Keeping a healthy body weight also reduces load through the forefoot with each step.

Which related problems should you treat early?

Bunions, hammertoes and flat feet alter forefoot loading and are linked with neuroma. Seeing a foot specialist about these early may help prevent a second problem. You can read more on flat feet and bunions, or browse the foot and ankle section for other conditions.

What cannot be prevented?

Inherited foot shape, anatomy of the nerve and some injuries cannot be changed. Many people with these risk factors never develop a neuroma, and many who do respond well to simple steps. If you notice early tingling that settles when you remove your shoes, act then, since that is the stage when change is most effective.

The outlook for Morton's neuroma is good: most people reach a comfortable foot with shoe changes, padding and injections, and surgery gives lasting relief to most of those who need it. Early treatment gives the best chance of avoiding an operation.

What is the natural course?

Without treatment, symptoms often come and go. Some people have long quiet spells when they use better shoes, while others find the pain increases over a year or two. A neuroma does not usually disappear on its own, but it can stop being a problem when the pressure is removed.

What results can you expect after non-surgical care?

Many people gain useful relief from footwear changes and a metatarsal pad within 4 to 8 weeks. An injection may help for weeks to months, and some people are comfortable for years afterwards. If symptoms return, you can repeat the steps or discuss surgery.

What is recovery like after surgery?

You walk on the heel or in a protective shoe straight after the operation. The foot is raised for the first 2 weeks, and stitches are removed at about 10 to 14 days. Swelling can last 3 months, and full comfort in normal shoes often takes 6 to 12 weeks.

When can you return to work and sport?

Desk work is often possible within about 1 to 2 weeks, standing jobs in 4 to 6 weeks, and running in about 8 to 12 weeks, depending on your recovery. Your surgeon will advise on driving, which depends on the foot and your pain control. Our rehabilitation guide describes what a good plan includes.

How long do results last?

Most people who have a neurectomy remain satisfied years later, though a minority continue to have some pain, and a few need a second operation. Staying in sensible shoes remains important. The goal is a foot that lets you work, walk and play with little or no pain.