Morton’s Neuroma

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Burning or “pebble-in-the-shoe” sensation between the toes? We diagnose and treat Morton’s neuroma with shoe strategy, met pads, custom orthotics, and targeted procedures when needed.

Morton’s neuroma is a thickening/irritation of a digital nerve in the forefoot—most commonly between the 3rd and 4th toes. Repeated pressure and compression can inflame the nerve, leading to pain and tingling in the toes.

Common symptoms

• Burning, stabbing, or “walking on a pebble” feeling in the ball of the foot
• Numbness or tingling into the adjacent toes
• Worse in narrow or stiff shoes; better barefoot or in wider, cushioned shoes
• Pain that flares with longer walks, running, or forefoot-loading activities

Why it happens (typical causes)

• Tight or pointed toe boxes; thin/rigid soles
• Forefoot overload (high heels, high arches, or flatfoot mechanics)
• Toe deformities (bunion, hammertoe) crowding the metatarsal heads
• Prior forefoot injury or repetitive impact

We begin with a focused history and exam, including squeeze tests and palpation over the affected web space.

• Weight-bearing X-rays help assess alignment and rule out other causes.
• Ultrasound can visualize the neuroma and guide injections; MRI is reserved for atypical or persistent cases.
  We also distinguish neuroma from metatarsalgia, plantar plate injury, or stress fracture.

Most patients improve with targeted offloading and shoe strategy.

Footwear & offloading

• Wider toe boxes and cushioned, flexible forefoot soles
• Metatarsal pads (properly placed just behind the metatarsal heads) to spread the toes and reduce nerve compression
• Consider rocker-sole options to reduce forefoot push-off stress

Custom orthotics & mechanics

• Custom orthotics with a met dome/cutout to redistribute pressure
• Address contributing mechanics (calf tightness, high/low arch issues)

Activity & symptom control

• Short-term activity modification; ice/contrast as appropriate
• Brief course of anti-inflammatory measures when suitable

Image-guided injections (select cases)

• Corticosteroid injections can reduce inflammation for stubborn flares
• Other options (e.g., alcohol sclerosing, radiofrequency/cryoablation) may be discussed when conservative care fails—we’ll review evidence, risks, and expectations together

If pain persists despite well-fitted shoes, precise met pad placement, and orthotics—plus appropriate injections—surgery may help.

• Intermetatarsal ligament release (decompression) can enlarge the space around the nerve
• Neurectomy (removal of the diseased nerve segment) for definitive relief in appropriate cases
  We’ll discuss benefits, risks (including permanent numbness between the affected toes and risk of stump neuroma), recovery timeline, and shoe/return-to-activity milestones.

1. Evaluation: Exam, footwear review, imaging as needed.
2. Plan: Same-day met pad placement guidance, shoe strategy, and orthotic plan; discuss procedures if necessary.
3. Follow-up: Re-check at 4–6 weeks to fine-tune pad position/orthotics and activity.

• Inability to bear weight after a specific injury
• Rapid swelling, redness, warmth, or fever
• Sudden focal pain with concern for stress fracture

• Board-certified care led by Hannah Lee, DPM
• Emphasis on evidence-based offloading and precise met pad placement
• Custom orthotics and ultrasound-guided treatments when appropriate
• Clear pathways from conservative care to decompression or neurectomy if needed

Is this the same as metatarsalgia?
They often feel similar. Metatarsalgia is pressure pain under the met heads; a neuroma causes burning/tingling and numbness between toes. They can coexist.

Will met pads make it worse?
When correctly placed, met pads spread the metatarsals and reduce nerve compression. Placement matters—we’ll mark the ideal spot.

Can a neuroma go away on its own?
Symptoms can calm with shoe/orthotic changes and activity tweaks. Chronic neuromas may need injections or, in some cases, surgery.

Will surgery leave me numb?
After neurectomy, numbness between the affected toes is expected. Most patients prefer numbness over recurrent burning pain; we’ll discuss this beforehand.

Let’s reduce nerve pressure and get you back to comfortable steps.