Morton's Neuroma

Overview

Morton's neuroma is a thickening of the tissue around one of the small nerves that run between the long bones of the foot to the toes. It most often affects the nerve between the third and fourth toes, and sometimes between the second and third. Despite the name, it is not a tumour — it is an irritated, swollen nerve that gets squeezed each time the forefoot takes weight.

The typical complaint is a burning or shooting pain in the ball of the foot, sometimes with tingling or numbness in the two affected toes. Many people describe it as walking on a pebble, a ruck in their sock or a hot marble under the foot. It is usually worse in narrow or high-heeled shoes and when walking or running for longer periods, and eases when you take your shoes off and rub the foot.

It affects women more often than men, most commonly between the ages of 40 and 60, and is frequently linked to footwear that squeezes the forefoot. Early, conservative management — changing shoes, offloading the nerve and addressing foot mechanics — is successful for many people.

Causes and risk factors

• Narrow, pointed or high-heeled shoes that compress the forefoot
• Flat feet or overpronation, which increase pressure on the ball of the foot
• Bunions, hammer toes or a high arch altering forefoot loading
• Running, racket sports or activities with repeated forefoot impact
• Being female, aged 40–60
• Previous forefoot injury

How we may be able to help

Assessment first. We reproduce your symptoms with specific tests, check for the characteristic "click" when the forefoot is squeezed, and rule out other causes of forefoot pain such as a stress fracture, joint inflammation under the toes or nerve entrapment elsewhere. If imaging or a medical opinion is needed — for example if symptoms are severe or not responding — we can arrange an online private GP consultation.

Reducing pressure on the nerve is the priority. Our 3D foot scan assesses how your forefoot loads, and custom orthotics can be made with a metatarsal dome — a small pad behind the ball of the foot that spreads the long bones apart and lifts pressure off the nerve. Many people find this makes walking considerably more comfortable.

Physiotherapy includes advice on footwear, manual therapy to improve mobility in the foot and ankle joints, and exercises to strengthen the foot and improve how load is shared across the forefoot. Kinesiology taping can be used to spread the metatarsals temporarily, and therapeutic ultrasound may be applied as an adjunct in some plans. If symptoms persist despite footwear changes and orthotics, an injection around the nerve is a recognised option; whether it is appropriate for you is decided with a doctor after assessment.

What you can do at home

• Switch to shoes with a wide, deep toe box and a low heel — this alone helps many people
• Avoid high heels and pointed shoes until symptoms settle
• Try an off-the-shelf metatarsal pad placed just behind the ball of the foot
• Reduce running and long walks temporarily; cycling and swimming are good alternatives
• Remove your shoes and gently massage the forefoot when it flares
• Roll the ball of the foot over a small ball for a few minutes daily to ease surrounding tissues