Overview
Morton neuroma is a painful condition affecting the ball of the foot, most commonly between the third and fourth toes. It involves thickening of tissue around one of the nerves leading to the toes, causing sharp, burning pain or a sensation of standing on a marble. It is strongly associated with narrow or high-heeled footwear.
How common is it?
Morton's neuroma is a recognised cause of pain in the ball of the foot. Narrow or high-heeled footwear can increase pressure on the affected nerve.
Causes and risk factors
Repetitive pressure or irritation causes the nerve to thicken (perineural fibrosis). The nerve is most vulnerable as it runs between the metatarsal heads.
Common risk factors
- Wearing high-heeled or pointed-toe shoes (compress metatarsals and nerve)
- Flat feet or high arches
- Tight, narrow footwear
- High-impact activities (running, ballet, sports with toe-off motion)
- Metatarsal stress fracture or bursitis
Symptoms
- Sharp, burning, or stabbing pain in the ball of the foot between toes
- Sensation of standing on a pebble or marble
- Numbness or tingling in the affected toes
- Pain worsened by tight footwear or walking and relieved by removing shoes and rubbing the foot
- Clicking sensation between the metatarsal heads (Mulder sign)
When to see a doctor
Seek assessment for severe or worsening forefoot pain, tingling or loss of feeling, or pain not improving after two weeks of self-care. If you have diabetes, seek advice for any new foot pain; a wound or hot, red, swollen foot needs same-day advice.
Diagnosis
Clinical diagnosis: Mulder test (squeezing the forefoot while pressing between the web spaces produces pain and click). Ultrasound confirms the diagnosis and measures neuroma size. MRI for uncertain cases.
Treatments
Footwear modification
Switching to wide, low-heeled shoes with good cushioning is the essential first step. A metatarsal dome insole redistributes pressure away from the nerve. Most mild cases resolve with footwear alone.
Corticosteroid injection
A specialist may offer a corticosteroid and local anaesthetic injection if simpler measures have not helped. Benefit varies and may be temporary. Tell the team if you have diabetes and ask about glucose monitoring.
Alcohol sclerotherapy
Alcohol injections are used by some specialists, but evidence and availability vary and they are not routine first-line care. Discuss possible benefits and harms with a foot specialist.
Surgical excision
Surgery may be offered if other treatment has not helped. Removing the nerve can leave permanent numbness in the affected toes; pain can persist or recur, so discuss benefits and risks.
Self-care and lifestyle
- Wear wide-fitting shoes with a low heel at all times, not just when symptomatic
- Avoid high heels and pointed-toe shoes entirely
- Use metatarsal insoles or custom orthotics
- If advised, use a wrapped cold pack briefly; do not apply ice to skin with reduced sensation or poor circulation, and ask your foot team if you have diabetes.
Prevention
Wearing correctly fitted, wide, low-heeled shoes is the most effective preventive measure. Footwear advice is particularly important for runners and those who wear formal shoes for prolonged periods.
Sources for targeted updates
Updated: 24 October 2026. Targeted corrections to urgent-care guidance, frequency, treatment, self-care, key facts. This update covers the named sections; a full review of the remaining guide is pending.