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• Morton’s neuroma is a nerve thickening between the metatarsal heads, most commonly between the third and fourth toes.
• The classic symptom is burning pain or numbness in the ball of the foot and toes, plus a "pebble in the shoe" sensation.
• It is more common in women and is closely linked to tight, narrow, or high-heeled shoes.
• First-line treatment is footwear changes, metatarsal pads, custom orthotics, and a corticosteroid injection if needed.
• Surgical neuroma removal is reserved for cases that fail conservative treatment.

What is Morton’s neuroma?

Morton’s neuroma is a benign thickening of a nerve between the long bones (metatarsals) of the foot, most often between the third and fourth toes. The nerve becomes irritated and swollen from chronic compression, causing burning pain, numbness, and a characteristic feeling that there's something — a pebble, a wrinkle in the sock — stuck in the shoe.

It is significantly more common in women than men and is strongly linked to footwear: narrow, pointed, or high-heeled shoes compress the metatarsals together and squeeze the nerve over years. Runners and active people whose forefoot is repeatedly loaded are also at risk. Foot types with low arches or hammertoes are more prone, because both increase pressure across the ball of the foot.

Our podiatrists at Northwest Extremity Specialists treat neuromas conservatively first — most cases improve significantly with shoe and padding changes alone. For cases that need more, a corticosteroid injection in the office often provides lasting relief. Surgical removal is the definitive treatment for stubborn cases but is reserved for after conservative care has been fully exhausted.

See it in motion

The interdigital nerves run between the metatarsal bones in the forefoot. They pass under a tight ligament called the deep transverse intermetatarsal ligament. When the metatarsals are squeezed together — by narrow shoes, high heels, or chronic mechanical pressure — the nerve gets pinched against that ligament. Over time it becomes inflamed and thickened, eventually forming what we call a neuroma. The third interspace (between toes 3 and 4) is by far the most common location, because the nerve there is the largest and the anatomy puts it at highest risk.

What it feels like

Morton’s neuroma has a fairly distinctive symptom pattern centered on the ball of the foot:

• Burning or sharp pain in the ball of the foot, especially between toes 3 and 4
• A "pebble in the shoe" or wrinkled-sock sensation
• Numbness or tingling in the affected toes
• Pain that worsens with tight shoes or high heels and improves with going barefoot
• Pain that's relieved by taking off the shoe and massaging the foot
• A clicking sensation when pressing on the affected interspace
• Symptoms that come and go for months before becoming constant

Why it develops

Morton's neuroma develops from chronic compression of the nerve. Common contributors:

• Tight, narrow, or pointed-toe footwear
• High heels that shift body weight onto the forefoot
• Repetitive forefoot loading from running or sport
• Foot types with low arches or flat feet
• Hammertoes or bunions that increase forefoot pressure
• Acute trauma to the forefoot in some cases

How we diagnose Morton’s neuroma

A typical neuroma exam includes a careful history and a hands-on test where the provider squeezes the forefoot from side to side while pressing on the interspace — this often reproduces the patient's pain and can produce a palpable click (Mulder's sign). X-ray is typically taken to rule out a stress fracture or arthritis of the metatarsal head. Ultrasound or MRI is sometimes used to confirm the size and location of the neuroma when surgical planning is being considered. Most patients leave the same day with a diagnosis and a clear plan.

Non-surgical care

The majority of neuromas improve significantly with conservative care. Our typical stepped approach:

• Wider, lower-heeled shoes with a deep toe box
• Metatarsal pads placed just behind the painful area to spread the metatarsals apart
• Custom orthotics with built-in metatarsal support
• Anti-inflammatory medication for flares
• Activity modification: less time in narrow shoes, less forefoot impact temporarily
• Corticosteroid injection (with or without local anesthetic) for cases that don't respond to the above
• Alcohol sclerosing injections in selected cases

Surgical care

Surgery is reserved for neuromas that have failed at least 6 months of conservative treatment including footwear changes, padding, and at least one corticosteroid injection. The most common procedure removes the affected portion of the nerve.

• Neurectomy — surgical removal of the thickened nerve, typically through a dorsal (top of foot) incision
• Decompression of the intermetatarsal ligament — releases the structure compressing the nerve

Neuroma surgery is typically a quick procedure with protected weight-bearing in a surgical shoe for 2–3 weeks. Most patients return to athletic shoes by 4–6 weeks and to full activity by 6–8 weeks. A small area of permanent numbness in the toes is expected when a neurectomy is performed — patients generally find this a fair tradeoff for resolving the pain.

When to see a specialist

• Forefoot pain that has lasted more than 2–3 weeks despite shoe changes
• Burning, numbness, or tingling in the toes
• Pain that's interrupting your ability to wear regular shoes
• Symptoms that come back every time you return to running or sport
• A "click" you can feel when squeezing the forefoot

Morton's neuroma is treated by any of our board-certified podiatrists across our 8 clinics. Surgical neurectomy, when needed, is performed by Dr. Mia Horvath and Dr. Thomas Melillo at our Tigard Locust office.

Frequently asked questions

• Metatarsalgia
  General ball-of-foot pain that often coexists with a neuroma
• Sesamoiditis
  Another ball-of-foot pain pattern, but located under the big toe
• Hammertoe
  Hammered toes shift weight onto the ball of the foot and can worsen neuroma symptoms
• Bunions
  Bunion-related forefoot changes can contribute to neuroma development