Key takeaways:
Morton’s neuroma is a type of neuropathy that affects the nerve between the long bones of the foot.
Signs and symptoms from Morton’s neuroma include foot pain, the feeling of a pebble in your shoe, and numbness or burning sensation worsened by pressure or walking.
Morton’s neuroma treatment includes supportive shoes with wide toe boxes, custom insoles, exercises, and rest. Surgery and various injections are also options if needed.
Morton’s neuroma is a condition that affects a nerve in the foot, causing pain and other symptoms. It most commonly happens between the third and fourth metatarsals (long bones) of your foot, but can develop in between any toes.This condition mostly affects middle-aged people and more frequently women.
Neuromas are benign (noncancerous) tumors that tend to occur after an injury to the nerve. But despite its name, Morton’s neuroma is not actually a tumor. Rather, it’s a type of neuropathy, because the symptoms come from aggravation and compression of the nerve in the foot. Experts believe it’s a result of soft tissue changes and swelling in the forefoot.
Because there are several possible causes of foot pain and numbness, it helps to know the signs and symptoms of each. Here we’ll discuss the different symptoms of Morton’s neuroma. Keep in mind, these symptoms typically affect only one foot. It’s rare to have a Morton’s neuroma in both feet.
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1. Pain
Pain in the ball of the foot is the most common symptom. It can be sharp or dull, and it could radiate into the toes. Squeezing the area between the bones with your thumb and finger can reproduce the pain.
Pain commonly worsens with walking because it puts pressure on the area where the nerve is compressed. It also gets worse with stretching of the foot.
A metatarsal pad or shoe inserts may help relieve pain by spreading out the pressure in the foot when walking.
2. Pebble sensation in shoe
People with Morton’s neuroma commonly report feeling as if they’re walking on a pebble or marble. This is because all of the soft tissue changes and swelling in the foot occupy space there.
Wide toe box shoes, a metatarsal pad, or other type of insert may help relieve the sensation.
3. Burning sensation in foot
Another symptom of Morton’s neuroma is burning in the ball of the foot and toes. This is due to the interdigital nerve being compressed when walking.
More on Morton’s neuroma treatment: These Morton’s neuroma exercises can help relieve your pain.
What is a neuroma, exactly? A neuroma is a growth of noncancerous nerves that causes pain. Learn more about this condition here.
Causes of numbness in toes and feet: Numbness in both feet probably isn’t from a Morton’s neuroma. Here are conditions that can cause numbness in your toes and feet.
It can help to rest and remove footwear for a period for the burning sensation to resolve.
4. Numbness in foot and toes
Similar to the burning sensation, you may have numbness in your toes (or between them) due to compression of the nerve. Footwear, rest, and shoe inserts can help with this symptom.
5. Problems with tight shoes or heels
Pain usually worsens with tight shoes or high heels. These can add pressure to the ball of the foot, further compressing the irritated nerve. Tight shoes can also make numbness or tingling worse.
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With a Morton’s neuroma, it’s helpful to wear flat shoes with a wide toe box (front end of the shoe). Roomier shoes can help alleviate pain.
6. Relief with rest
Resting will alleviate the pressure and stress placed on the neuroma. So pain and other symptoms are usually relieved with rest. When dealing with Morton’s neuroma it helps to take short rest breaks when exercising or walking for long periods of time.
7. Clicking sensation in foot
Some people might feel this in the ball of the foot between the bones with tight-fitting shoes. But this can also be recreated by a foot specialist examining your foot. The sound or feeling of a click while squeezing your foot is referred to as Mulder’s sign.
8. Increased distance between toes
Depending on the size of the neuroma, it can widen the space in between the bones, and the toes appear to be spread out. This is called Sulivan’s sign. More commonly, you might not notice a change in appearance, but your healthcare professional could see it on an X-ray. This is called the Vulcan salute sign.
Frequently asked questions
There are several other foot conditions that have similar symptoms to Morton’s neuroma. These include:
Metatarsal stress fracture: A metatarsal stress fracture crack in the bone due to overuse causes pain with activity.
Tarsal tunnel syndrome: This causes shooting pain, numbness, and tingling in the foot due to compression of a different nerve at the ankle.
Freiberg’s disease: Freiberg’s disease is a rare condition that causes destruction of the metatarsal bone.
Plantar fasciitis: Plantar fasciitis causes pain in the bottom of the foot due to tightening of tissues.
If your foot pain isn’t getting better with conservative measures, consider getting checked out by a healthcare professional to help with a diagnosis.
There are several imaging studies to assist in confirming a Morton’s neuroma. MRI is usually a good choice for imaging soft tissues. But with technological advancements, ultrasound of the foot has shown similar accuracy in diagnosing and is more affordable.
Traditionally, nonsurgical treatments include rest, anti-inflammatory medications, and exercises. Wearing shoes with wide toe boxes, custom insoles, or increased cushion can also help.
Other treatment options include corticosteroid injections, chemical neurolysis (injecting a chemical to destroy the nerve), and radiofrequency ablation (using heat to the nerve to interrupt the pain signal to the brain). These are usually performed with ultrasound to guide placement of the needle.
If nonsurgical treatments don’t work, removing the affected portion of the nerve or surrounding tissues via surgery is usually successful.
If you have foot pain that you believe may be Morton’s neuroma, you can try changing shoes or adding extra padding to relieve the pain. If there’s no improvement in a few days to weeks, you should see your healthcare professional.
You should get immediate care if you have a sudden foot injury, chronic medical conditions, or additional symptoms (like swelling, redness, warmth, or fever). These could indicate something more serious.
There are several other foot conditions that have similar symptoms to Morton’s neuroma. These include:
Metatarsal stress fracture: A metatarsal stress fracture crack in the bone due to overuse causes pain with activity.
Tarsal tunnel syndrome: This causes shooting pain, numbness, and tingling in the foot due to compression of a different nerve at the ankle.
Freiberg’s disease: Freiberg’s disease is a rare condition that causes destruction of the metatarsal bone.
Plantar fasciitis: Plantar fasciitis causes pain in the bottom of the foot due to tightening of tissues.
If your foot pain isn’t getting better with conservative measures, consider getting checked out by a healthcare professional to help with a diagnosis.
There are several imaging studies to assist in confirming a Morton’s neuroma. MRI is usually a good choice for imaging soft tissues. But with technological advancements, ultrasound of the foot has shown similar accuracy in diagnosing and is more affordable.
Traditionally, nonsurgical treatments include rest, anti-inflammatory medications, and exercises. Wearing shoes with wide toe boxes, custom insoles, or increased cushion can also help.
Other treatment options include corticosteroid injections, chemical neurolysis (injecting a chemical to destroy the nerve), and radiofrequency ablation (using heat to the nerve to interrupt the pain signal to the brain). These are usually performed with ultrasound to guide placement of the needle.
If nonsurgical treatments don’t work, removing the affected portion of the nerve or surrounding tissues via surgery is usually successful.
If you have foot pain that you believe may be Morton’s neuroma, you can try changing shoes or adding extra padding to relieve the pain. If there’s no improvement in a few days to weeks, you should see your healthcare professional.
You should get immediate care if you have a sudden foot injury, chronic medical conditions, or additional symptoms (like swelling, redness, warmth, or fever). These could indicate something more serious.
The bottom line
Morton’s neuroma causes pain in the foot, a sensation of walking on a pebble, and sometimes numbness and tingling. These symptoms are due to compression and irritation of the nerve that runs between the long bones of the foot. They are usually worse with activity and tight-fitting shoes or heels. Conservative treatment includes rest, changes in footwear, and exercises. It’s a good idea to get medical attention if symptoms of Morton’s neuroma persist, or if you have other symptoms.
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References
Bignotti, B., et al. (2015). Ultrasound versus magnetic resonance imaging for Morton neuroma: Systematic review and meta-analysis. European Radiology.
Braig, Z. V., et al. (2022). Stress fractures of the foot and ankle. OrthoInfo.
Connors, J. C. (2023). Freiberg disease. Merck Manuals.
Galley, J., et al. (2022). The Vulcan salute sign: A non-sensitive but specific sign for Morton’s neuroma on radiographs. Skeletal Radiology.
Klontzas, M. E., et al. (2021). Ultrasound-guided treatment of Morton’s neuroma. Journal of Ultrasonography.
Larson, E. E., et al. (2005). Accurate nomenclature for forefoot nerve entrapment: A historical perspective. Journal of the American Podiatric Medical Association.
Latinovic, R., et al. (2006). Incidence of common compressive neuropathies in primary care. Journal of Neurology, Neurosurgery, and Psychiatry.
Munir, U., et al. (2023). Morton neuroma. StatPearls.
Padua, L., et al. (2020). Relationship between sensory symptoms, Mulder’s sign, and dynamic ultrasonographic findings in Morton’s neuroma. Foot & Ankle International.
Skinner, W. C., et al. (2022). Morton’s neuroma. OrthoInfo.
