Morton’s neuroma is a painful condition affecting the ball of the foot, usually between the third and fourth toes. It occurs when a digital nerve in your foot becomes irritated or thickened, often as a result of repetitive compression or friction.

People with Morton’s neuroma frequently describe a burning, sharp, or tingling pain in the forefoot, sometimes accompanied by numbness or a sensation of walking on a small stone. This can affect walking, running, and even standing for prolonged periods, significantly reducing quality of life.

At London Bridge Orthopaedics, we provide specialist assessment and personalised treatment, including conservative measures and surgical options, to relieve pain and restore foot function.

Who is affected by Morton’s Neuroma?

Morton’s neuroma most commonly occurs in adults aged 40–60, though it can affect younger people who place repetitive stress on the forefoot.

Risk factors include:

• Footwear – tight, narrow, or high-heeled shoes can compress the forefoot
• Foot structure – flat feet, high arches, or bunions can increase pressure on the nerves
• Activities – runners, dancers, or those who perform high-impact sports
• Repetitive trauma – occupations or hobbies involving prolonged standing or walking

Women are affected more often than men, likely due to footwear and foot structure differences.

Symptoms of Morton’s Neuroma

Symptoms of Morton’s neuroma may develop gradually or appear suddenly after increased activity or footwear changes.

Common features that people present with include:

• Burning pain in the ball of the foot, often radiating into the toes
• Tingling or numbness between the affected toes
• Feeling of walking on a pebble or fold in the sock
• Pain worsened by tight shoes or prolonged walking
• Temporary relief when barefoot or massaging the foot

Left untreated, the condition may progressively limit activity and cause chronic discomfort.

Assessment and diagnosis

Diagnosis begins with a detailed history and clinical examination:

• Palpation – tenderness is usually present between the affected metatarsals
• Reproduction tests – squeezing the forefoot may elicit symptoms (Mulder’s click)
• Gait assessment – to identify biomechanical contributions

Imaging can help confirm the diagnosis and exclude other causes of forefoot pain:

• Ultrasound – detects thickening of the digital nerve and associated changes
• MRI – may be used in complex or unclear cases to visualise soft tissue and rule out alternative pathology

Accurate assessment ensures treatment is targeted to the specific nerve and foot anatomy.

Aggravating factors

Symptoms are often triggered or worsened by:

• High-heeled or narrow shoes
• Running or high-impact exercise
• Prolonged standing or walking
• Foot deformities such as bunions or hammer toes

Recognising these triggers is essential for effective conservative management and post-surgical rehabilitation.

Conservative management

Many patients experience relief without surgery. Initial treatments focus on reducing nerve irritation and mechanical stress:

• Footwear modification – wider, supportive shoes with a low heel
• Orthotics – metatarsal pads or insoles to redistribute pressure
• Activity modification – reducing high-impact activity temporarily
• Corticosteroid injections – targeted around the neuroma to reduce inflammation and pain

Conservative strategies are usually tried for several months before surgery is considered.

Studies show that these measures can provide lasting relief in a significant proportion of patients, particularly when combined with correct footwear and activity adjustment.

Surgical treatment

Surgery is considered when conservative management fails or symptoms persist for several months, limiting walking, standing, or recreational activity. The goal of surgery is to remove the affected nerve segment, permanently relieving pain while accepting a small area of permanent numbness between the toes.

What the procedure involves

• Day-case operation – performed under regional or general anaesthetic
• Incision placement – either on the top (dorsal) or bottom (plantar) of the foot, depending on neuroma location and surgeon preference
• Excision of the neuroma – the thickened portion of the digital nerve is carefully removed
• Tissue preservation surrounding nerves, tendons, and blood vessels are protected

The operation typically lasts 30 – 45 minutes and patients can usually go home the same day.

Post-operative recovery

• Protected weight-bearing – in a post-operative shoe for 2 – 3 weeks
• Swelling and discomfort – expected for several weeks; elevation and ice help manage symptoms
• Gradual return to normal footwear – usually within 4 – 6 weeks
• Return to high-impact activities – often after 6 – 8 weeks depending on comfort and healing

Recovery is progressive, and most patients regain normal walking patterns with long-term relief from pain.

Outcomes and prognosis

Surgical excision of Morton’s neuroma is highly effective. Clinical studies report:

• Long-term pain relief in 75 – 90% of patients
• Permanent numbness between the affected toes is typical but rarely problematic
• High patient satisfaction due to restored comfort and mobility

While surgery does not prevent the development of neuromas elsewhere, careful assessment, footwear adjustment, and post-operative management minimise future risk.

When to seek specialist advice

It is important to consult a specialist if:

• Forefoot pain persists despite shoe changes, orthotics, or injections
• Pain interferes with walking, work, or recreational activity
• You notice tingling, numbness, or a “stone-like” sensation in the toes
• Symptoms recur or progressively worsen

Early assessment allows targeted treatment and can prevent chronic forefoot dysfunction.

FAQs – Morton’s Neuroma

Can Morton’s neuroma heal without surgery?
Yes, many patients respond well to conservative treatments such as footwear changes, orthotics, and injections, especially if the neuroma is detected early.

When is surgery recommended?
Surgery is considered when conservative management fails, symptoms persist for several months, or daily life is significantly affected.

Is the surgery painful?
The operation is performed under anaesthetic. Some post-operative discomfort and swelling are expected but manageable with simple analgesia.

Will I have numbness after surgery?
Yes, a small area of permanent numbness between the toes is normal but is generally well tolerated.

How soon can I walk normally after surgery?
Most patients walk immediately in a post-operative shoe. Normal footwear is usually resumed at 4 – 6 weeks, with a gradual return to high-impact activity thereafter.

Can the neuroma come back after surgery?
Recurrence is uncommon when surgery is performed correctly and conservative measures are continued as appropriate.

References

Kasparek, M. and Schneider, W., 2013. Surgical treatment of Morton’s neuroma: clinical results after open excision. International orthopaedics, 37(9), pp.1857-1861.