Morton’s Neuroma: Understanding the Burning Pain in the Ball of Your Foot
What is Morton’s Neuroma?
Morton’s Neuroma is a common and painful condition that affects the ball of the foot, most often between the third and fourth toes. It occurs when a nerve that runs between the metatarsal bones becomes irritated, thickened, or compressed, leading to pain, tingling, or a sharp “pebble-in-the-shoe” sensation when walking.
Over time, this irritation causes the nerve to swell and become more sensitive, especially when wearing tight shoes or high heels that squeeze the front of the foot.
Common Symptoms
Sharp or burning pain in the ball of the foot
Tingling or numbness in the toes
Feeling like there’s a lump or fold in your sock
Pain that worsens with tight shoes or long periods of standing
If left untreated, the pain can progress from intermittent discomfort to persistent pain even when barefoot.
What Causes Morton’s Neuroma?
Several factors can lead to nerve compression in the forefoot:
Tight or narrow footwear: Shoes that squeeze the toes together, such as high heels or narrow dress shoes.
Repetitive stress: Running, jumping, or dancing can repeatedly irritate the nerve.
Foot structure: Flat feet, high arches, or bunions alter foot mechanics and increase pressure between the metatarsal heads.
Occupational or lifestyle factors: Jobs or hobbies that involve long hours on your feet.
Treatment Options
Conservative (Non-Surgical) Approaches
1. Footwear Modification
Choose wide-fitting shoes with low heels and plenty of toe space. Avoid tight or pointed shoes that compress the front of the foot. Soft, cushioned soles or insoles can also reduce forefoot pressure.
2. Padding and Orthotics
Metatarsal pads or custom orthotics designed by a podiatrist can offload pressure from the affected nerve. These devices also correct underlying biomechanical issues such as overpronation.
3. Activity Modification
Reduce high-impact activities like running or jumping and switch to low-impact alternatives such as swimming or cycling until symptoms improve.
4. Physical Therapy
Stretching, mobilisations, and strengthening of intrinsic foot muscles improve stability and load distribution across the forefoot.
5. Medication and Modalities
NSAIDs to relieve inflammation and pain
Ice therapy after activity to reduce swelling
Shockwave or low-level laser therapy to promote healing and nerve desensitisation
Injection Therapies
Corticosteroid Injections. Targeted injections can reduce local inflammation and irritation around the nerve, often providing lasting relief.
Alcohol Sclerosing Injections. A series of dilute alcohol injections can shrink or desensitise the affected nerve. This is often used when other conservative measures bring only short-term relief.
Local Anaesthetic or Radiofrequency Ablation. Minimally invasive techniques that temporarily block or disrupt the nerve’s pain signals.
Surgical Options (Last Resort)
Neurectomy (Nerve Removal)
The thickened nerve segment is removed through a small incision. Surgery is usually considered when non-surgical treatments have failed for 6–12 months. It can offer long-term relief but may leave some numbness between the toes.
Decompression Surgery
Instead of removing the nerve, tight ligaments or nearby tissues are released to relieve pressure — a preferred option when nerve preservation is desired.
Recovery and Prevention
Post-treatment care focuses on supportive footwear, custom orthotics, and a gradual return to activity. Addressing biomechanical issues early helps prevent recurrence.
Important Facts About Morton’s Neuroma
It’s not a true “neuroma.”
Despite the name, Morton’s Neuroma isn’t a tumour — it’s a fibrotic thickening of the nerve tissue caused by chronic irritation.
Location matters.
It most commonly develops between the third and fourth toes, where two digital nerves join, making this area especially prone to compression.
It can mimic other conditions.
Symptoms often resemble metatarsalgia, capsulitis, bursitis, or even stress fractures — which is why accurate diagnosis by a podiatrist is essential.
Pain can fluctuate. Symptoms may appear only when wearing certain shoes and gradually worsen over time. Early treatment leads to better outcomes.
Footwear is the biggest trigger. Simply changing to wider, cushioned shoes can dramatically improve symptoms in early stages.
It’s more common in women and active adults. High heels, fashion footwear, and sports that load the forefoot increase risk.
Untreated cases can lead to permanent damage. Chronic nerve compression can cause irreversible thickening or degeneration, making pain harder to manage later.
When to See a Podiatrist
If you experience burning, tingling, or sharp forefoot pain, don’t ignore it.
Early intervention can prevent chronic pain and help you stay active and comfortable.
Book a consultation at Relief Podiatry to assess your foot mechanics, confirm your diagnosis, and explore effective treatment options for long-term relief.
