Morton’s neuroma is not a tumor. Despite its name, which sounds like it describes a growth, the condition is actually fibrosis of a nerve in the foot. No abnormal cells are multiplying, and nothing is growing out of control. What’s happening is that the tissue surrounding a nerve between your toe bones has thickened and scarred, compressing the nerve and causing pain.
Why the Name Is Misleading
A true neuroma is a mass of nerve tissue, often a benign tumor. Morton’s “neuroma” doesn’t fit that definition. When pathologists examine the affected tissue under a microscope, they find swelling inside the nerve, damage to the protective coating around nerve fibers, and a buildup of scar-like fibrous tissue around the nerve. They also see changes in the small artery that supplies blood to the nerve, including damage to the artery wall and clotting. These are signs of chronic irritation and compression, not tumor growth.
A more accurate name would be perineural fibrosis, meaning scarring around a nerve. Some medical sources call it an interdigital neuritis or use the older name Civinini-Morton syndrome. But “Morton’s neuroma” stuck, and it’s what most doctors and patients use.
What Causes the Nerve to Thicken
The nerve most commonly affected runs between the third and fourth toes in the ball of the foot. This spot is especially vulnerable because the nerve passes through the narrowest space between the long bones of the foot, directly underneath a tough ligament. The nerve is less mobile here during weight bearing, which makes it prone to repeated compression. The fourth toe bone also sits on a more mobile joint than the third, and some researchers believe this mismatch creates extra friction on the nerve between them.
Several factors contribute to the problem. Tight, narrow shoes and high heels increase compression on the nerve, which helps explain why women are affected about five times more often than men. The average age at surgery is around 50. Limited ankle flexibility has also been linked to the condition, likely because it changes how pressure distributes across the forefoot during walking. Trauma to the area can play a role as well. The exact cause in any individual case often involves a combination of anatomy, footwear, and repetitive stress.
What It Feels Like
The hallmark sensation is pain in the ball of the foot, usually between the third and fourth toes. People often describe it as feeling like they’re standing on a marble or a stone inside their shoe. The pain can be stabbing, shooting, or burning, and it frequently radiates into the two toes on either side of the affected nerve. Tingling, pins and needles, or numbness in those toes is common. Some people notice a clicking sensation in the forefoot when walking.
Symptoms typically get worse with activity, especially in tight shoes, and improve with rest or going barefoot. Pain when spreading or stretching the toes is another characteristic sign. Because intermetatarsal bursitis, an inflammation of a small fluid sac in the same area, produces very similar symptoms, the two conditions can be hard to tell apart without imaging. Patients with Morton’s neuroma tend to report higher pain levels and a longer history of symptoms compared to those with bursitis alone.
How It’s Diagnosed
Doctors often start with a physical exam that includes squeezing the forefoot to see if it reproduces the pain or produces an audible click, known as Mulder’s sign. This test is widely used, but its accuracy varies considerably. Studies show its sensitivity ranges from 29% to 94%, meaning it catches the condition reliably in some hands but misses it in others. It’s a useful starting point, not a definitive answer.
When imaging is needed, both ultrasound and MRI perform well. A meta-analysis comparing the two found ultrasound had a sensitivity of 91% and MRI had 90%, with no significant difference between them. MRI had a slight edge in specificity, correctly ruling out the condition in virtually all negative cases. Ultrasound is often used first because it’s faster, cheaper, and lets the examiner move the foot during the scan.
Treatment Without Surgery
The first step is almost always changing your shoes. Switching to footwear with a wide toe box and low heel reduces compression on the nerve and can significantly improve symptoms on its own. Cushioning pads or custom orthotics that spread the metatarsal bones apart are another conservative option.
Steroid injections into the area around the nerve are a common next step. They provide the most pain relief within the first one to three months, but the effect tends to fade. Pain scores in studies typically rise again around six months after injection. Across multiple studies, about 30% of patients who received steroid injections eventually needed surgery because their pain returned or never fully resolved. Still, for many people the injections buy meaningful time or provide enough relief to avoid an operation altogether.
When Surgery Is Considered
If conservative measures fail after several months, surgical removal of the affected nerve segment (neurectomy) is the standard procedure. Results depend partly on the surgical approach. In one comparative study, all patients who had the nerve removed through an incision on the sole of the foot achieved relief of their preoperative symptoms, though some developed painful scars. Patients who had the more common approach through the top of the foot had a 68% rate of complete symptom resolution, but six cases developed a stump neuroma, a painful regrowth of nerve tissue at the cut end.
Recovery from neurectomy typically means several weeks of limited weight bearing. The trade-off is permanent numbness in the web space between the affected toes, since the nerve that provided sensation there has been removed. For most patients this numbness is a minor inconvenience compared to the pain they had before surgery.