Is Morton's neuroma serious?

It is not dangerous, but it can be painful enough to affect your walking and daily activities. It responds well to treatment, and most people avoid surgery altogether.

Will I definitely need an operation?

No. Many people improve with a change of footwear, padding or an injection. Surgery is only suggested when simpler measures have not given lasting relief.

How soon can I walk normally again after surgery?

You will usually wear a special shoe for about two weeks and then return to trainers, with most people back to their normal activities by around six weeks.

Can it come back after treatment?

Recurrence is uncommon after surgery. Choosing roomier footwear afterwards helps to protect the foot and reduce the chance of further irritation.

Foot & Ankle

Morton's Neuroma (Pinched Nerve in the Foot)

Medically reviewed by Mr Vasu Karri, Medical Director and Plastic Surgeon BSc(Hons), MBBS, MSc, FRCS(Plast).

Morton's neuroma is a thickened nerve in the ball of the foot that causes a sharp, burning pain between the toes. It often feels worse in tight or narrow shoes and eases when you take your shoe off. The condition is common and very treatable, and most people improve with simple changes before any operation is considered.

What is Morton's neuroma?

In short

Morton’s neuroma is a thickened, irritated nerve in the ball of the foot, usually between the third and fourth toes. It is common, not dangerous, and most people improve without surgery.

A neuroma is a nerve that has become thickened and irritated where it passes between the long bones of the foot, known as the metatarsals. In Morton’s neuroma the affected nerve usually sits between the third and fourth toes, although the space between the second and third toes can also be involved.

The nerve becomes squeezed as it travels between the bones, and over time this pressure makes it swell and grow more sensitive. Tight footwear, high heels and activities that load the ball of the foot can all add to the irritation.

What it feels like

Most people describe symptoms in the ball of the foot that spread into the toes, such as:

A sharp, shooting or burning pain in the ball of the foot.
Numbness or tingling in the toes.
A feeling like standing on a small pebble or a fold in your sock.

The pain tends to build during the day and is usually worse in firm, narrow or closed-in shoes. Slipping the shoe off and rubbing the foot often brings quick relief.

How we diagnose it

A careful history and examination are the most important parts of reaching the right diagnosis. During the examination we gently squeeze the foot from side to side while pressing into the space between the bones, which can produce a small click and reproduce your symptoms.

Where a scan is helpful, ultrasound is the most reliable way to confirm a neuroma. We carry this out at the time of your consultation so the findings can be matched directly to your symptoms rather than read in isolation.

Treatment options

Treatment almost always begins with simple measures and only steps up if your symptoms continue:

Footwear and padding: a lace-up shoe with a wide, deep front takes pressure off the nerve, and a small pad placed behind the ball of the foot helps to spread the bones apart.
Steroid injection: reduces the swelling and inflammation around the nerve and can settle the pain, particularly for smaller neuromas.
Alcohol injections: for some people a short course is used to shrink the nerve, always carried out under ultrasound guidance.
Surgery: considered when other measures have not given lasting relief. The irritated section of nerve is removed through a small cut on either the top or the sole of the foot, and it is usually very effective at relieving the pain.

Recovery

Most people rest the foot in a supportive post-operative shoe for about two weeks. After this you can usually return to trainers and build up your walking as comfort allows, and gentle stretching and massage of the toes helps to reduce swelling and keep the area supple.

If the cut is made on the sole of the foot, recovery can take a little longer. The majority of people are back to their normal activity by around six weeks.

Risks

Every procedure carries some risk, although serious problems are uncommon.

In the short term: there may be swelling, a small chance of infection, and rarely a blood clot, all of which are reduced by keeping the foot elevated in the early days.
In the longer term: a small number of people notice some ongoing numbness in the toes or occasional discomfort, which usually improves as the foot settles.