Morton’s neuroma is a painful condition affecting the ball of the foot, most commonly between the third and fourth toes. It occurs when the digital nerve that runs between the metatarsal bones becomes irritated, thickened, or compressed. This thickening is not a true tumour, but rather a fibrous build-up around the nerve in response to chronic pressure or friction. The condition is particularly common in people who wear tight or high-heeled shoes, which squeeze the forefoot, or in those with foot biomechanics that increase forefoot loading; such as flat feet or high arches.
The hallmark symptom of Morton’s neuroma is a sharp, burning, or shooting pain in the ball of the foot that may radiate into the toes. Many people describe the sensation as feeling like there is a pebble or fold in their sock. Tingling, numbness, or a pins-and-needles sensation between the toes can also occur. Symptoms are often aggravated by walking, running, or wearing tight shoes, and may ease with rest or removal of footwear. Over time, as the nerve becomes increasingly irritated, pain can become more persistent and severe.
It disproportionately more often affects middle-aged women but can affect all age and genders. The pain tends to radiate into the toes often causing a burning or tingling sensation and may be aggravated by wearing tight-fitting shoes.
Initial treatment for Morton’s neuroma focuses on reducing pressure on the affected nerve. This may include footwear modification - choosing wider shoes with a lower heel and cushioned sole—along with the use of metatarsal pads or custom orthotics to offload the forefoot. In many cases, physiotherapy, ultrasound-guided corticosteroid injections, or shockwave therapy can help relieve pain and inflammation.
When conservative management fails to provide lasting relief, surgery may be considered. The most common procedure is a neurectomy, where the affected portion of the nerve is removed. This is typically done under local or general anaesthesia and can be performed through a dorsal (top of the foot) or plantar (sole) approach. Post-surgery, patients usually experience significant pain relief, although some may develop residual numbness between the toes. Recovery can take several weeks, during which time activity is gradually increased as swelling subsides.
In some cases, decompression surgery - where surrounding structures that are compressing the nerve are released rather than removing the nerve itself - may be an alternative. The choice of procedure depends on the severity of the neuroma, patient activity level, and the surgeon’s preference. While surgery generally has a good success rate, potential risks include infection, scar sensitivity, or recurrence of symptoms.
