Toes & Forefoot
Morton's Neuroma
About Your Condition
Morton's neuroma is a condition in which one of the small nerves running between the metatarsal bones becomes thickened and irritated, usually in the third interspace (between the third and fourth toes). Despite the name, it is not a true tumour — it is a benign enlargement of the nerve sheath caused by repeated compression. Narrow or high-heeled footwear is the most common contributing factor.
The characteristic symptoms are burning, shooting, or electric pain in the ball of the foot, often radiating into the adjacent toes, and a sensation of standing on a pebble or bunched-up sock. Symptoms are typically worse in narrow or high-heeled footwear and relieved by removing the shoe and massaging the foot.
Non-Operative Management
Some patients find that symptoms settle with footwear changes alone, though it is unlikely to resolve without some change to footwear habits.
Footwear Modification
- Wearing shoes with a wide toe box is the single most important step — narrow footwear compresses the metatarsals together, directly aggravating the neuroma.
- Avoid high heels — they increase forefoot pressure considerably. A shoe with a slightly stiffer sole reduces forefoot flexibility and limits nerve irritation.
Orthotics and Padding
- A metatarsal dome or pad placed just behind the affected interspace spreads the metatarsal heads apart, reducing direct compression of the nerve.
- Custom orthotics may provide additional benefit if there are underlying biomechanical factors.
Corticosteroid Injection
- A cortisone injection under ultrasound guidance by an experienced radiologist is an effective treatment that can provide lasting relief in some patients. It is, however, quite painful, and tends to be offered as a diagnostic or bridging treatment for patients who don't want, or aren't ready for, surgery.
When to Consider Surgery
Surgery is considered when symptoms significantly limit your daily activities despite an adequate trial of non-operative treatment.
The operation offered is a dorsal neurectomy.