A Morton’s neuroma is a painful thickening of tissue around a nerve in the ball of your foot, most often between the third and fourth toes. Despite its name, it’s not a true tumor. The nerve becomes surrounded by scar-like fibrous tissue that compresses and irritates it, producing sharp pain, numbness, or the sensation that you’re standing on a marble. Women are diagnosed roughly three times more often than men, and the median age at diagnosis is around 56.
What’s Actually Happening Inside Your Foot
Between each pair of metatarsal bones (the long bones leading to your toes), a small nerve runs along the underside of your foot. In a Morton’s neuroma, the tissue wrapping around one of these nerves thickens and tightens. Under a microscope, the nerve fibers show signs of degeneration, and the normal architecture is replaced by dense, disorganized scar tissue. This process, called perineural fibrosis, is what distinguishes a Morton’s neuroma from other causes of forefoot pain.
Neuromas typically produce symptoms once they reach about 5 millimeters in diameter. Most develop in the space between the third and fourth toes, though the second intermetatarsal space is the next most common location.
What It Feels Like
The hallmark symptom is pain in the ball of the foot, the fleshy pad between your toes and arch. People commonly describe it as stabbing, shooting, or burning. Many say it feels like walking on a pebble or marble that you can’t shake out of your shoe. You may also notice tingling, pins and needles, or numbness spreading into the two toes on either side of the affected nerve. Some people feel an audible or tactile click in the forefoot when they walk.
Symptoms tend to worsen in tight shoes and during activities that put pressure on the ball of the foot, like running or even prolonged standing. They often ease when you sit down, remove your shoes, or massage the area. In the early stages, the pain may come and go. Over time, as the fibrous tissue thickens further, it can become constant.
Risk Factors
Anything that increases compression or irritation of the forefoot nerves raises your risk. Narrow, tight-fitting shoes and high heels are the most commonly cited culprits, because they squeeze the metatarsal bones together and shift body weight onto the ball of the foot. Foot deformities like bunions, hammertoes, and flat feet change how weight is distributed during walking and can place chronic stress on the intermetatarsal nerves. High-impact sports that involve repetitive forefoot loading, such as running and court sports, also contribute.
How It’s Diagnosed
Diagnosis usually starts with a physical exam. Your doctor will press on the bottom of your foot and squeeze the metatarsal heads together to reproduce the pain. One specific test, called the Mulder’s click, involves compressing the forefoot while pressing on the affected space from below. If the examiner feels a palpable click and you feel your typical pain, it’s a strong indicator. That said, this test has a sensitivity of about 61%, meaning it catches roughly six out of ten neuromas. Larger neuromas (averaging around 11 mm) are more likely to produce a positive click than smaller ones (around 8.5 mm).
Ultrasound and MRI are the two main imaging options, and they perform similarly. Ultrasound detects about 79% of surgically confirmed neuromas, while MRI catches around 76%. Both have difficulty visualizing very small neuromas under 5 mm. Ultrasound is generally faster, cheaper, and can be done in the office, which makes it the more common first choice. MRI is sometimes used when the diagnosis is uncertain or when other conditions need to be ruled out.
Conservative Treatment
Most people start with non-surgical approaches. The simplest change is switching to shoes with a wider toe box and lower heel, which reduces compression on the nerve. Metatarsal pads are inexpensive, adhesive cushions that can be placed inside your shoe to spread the metatarsal bones apart and take pressure off the nerve. The key to placement is positioning the pad just behind the metatarsal heads, not directly under the ball of the foot. Placed correctly, the pad lifts and separates the bones slightly, giving the nerve more room.
Corticosteroid injections can reduce inflammation and provide relief, but the results are often temporary. About 30% of patients get a durable response from a single injection, while roughly 50% experience temporary improvement that fades. A second injection after a partial response works about 40% of the time. Overall, only about 35% of patients report complete satisfaction with injection-based treatment, and around 15% eventually go on to need surgery.
Alcohol sclerosing injections (sometimes called alcohol ablation) offer a middle ground. This approach uses a series of injections to chemically shrink the nerve tissue. Success rates are higher than steroid injections, at roughly 68 to 70%, though they require multiple visits over several weeks.
When Surgery Becomes the Option
If conservative treatment fails after several months, surgery is the next step. The two main procedures are neurectomy (removing the thickened portion of the nerve) and neurolysis (releasing the tissue compressing the nerve without removing it).
Satisfaction rates for both are significantly higher than for injections. Neurolysis achieves complete satisfaction in about 63% of patients, and neurectomy in about 57%. The need for additional surgery afterward is low: around 2% for neurolysis and 5% for neurectomy, compared to 15% for patients initially treated with injections alone. Neurectomy does result in permanent numbness between the affected toes, since part of the nerve is removed. For most people, this trade-off is worth it when the alternative is chronic pain.
What Recovery From Surgery Looks Like
After a neurectomy, you can stand and bear weight carefully using crutches right away, but the first two weeks are about rest. You’ll wear a special postoperative shoe and keep your foot elevated above hip level as much as possible, limiting walking to essential trips like getting to the bathroom.
At the two-week mark, most people can ditch the crutches and the surgical shoe and transition into a roomy training shoe. Normal daily activities resume gradually from there. Impact sports like running, jumping, or court sports are typically off-limits until about 12 weeks after surgery, depending on how your recovery is progressing. The incision site and surrounding tissue continue to heal and settle for several months, so some residual swelling or sensitivity in the forefoot during that period is normal.