Morton’s Neuroma Treatment | Pain in the Ball of the Foot

Shoes are often the fix: A wider, lower shoe takes the squeeze off the nerve, and for many people that is enough.
Not a tumour: It is a thickened, irritated nerve, not a growth, and it does not spread.
Surgery has a trade-off: Removing the nerve usually leaves that space between the toes permanently numb.

Your options, and what each trades off

Morton's neuroma treatment is a sequence of steps, and most people stop at the first or second. The choice worth thinking about is surgery, because its benefit comes with a cost that is easy to overlook.

	Shoes and a pad	An injection	Surgery
How it helps	Takes the squeeze off the nerve and spreads the bones apart	Settles the irritation around the nerve	Removes the thickened nerve, or frees it
Is it often enough?	For many people, yes	For some, sometimes needing a repeat	Usually, when the first two have failed
What it costs you	Wearing different shoes	A brief, sharp injection; relief may fade	Permanent numbness between two toes if the nerve is removed
Time off your feet	None	None	Weeks in a protective shoe

A painful ball of the foot is not always a neuroma. A stress fracture of one of the long foot bones can feel similar, especially after a rise in running or walking — and it is treated very differently. A sharp, local pain that worsens with each session, or swelling on the top of the foot, is worth having checked rather than assumed.

What is actually squeezed

The front of a foot seen from the sole with the bones and nerves shown. A red swelling on the nerve between the third and fourth toe bones is labelled neuroma; beyond it the nerve splits towards the facing sides of those two toes. An inset shows a normal foot. — The nerve running between the third and fourth toe bones has thickened where the bones meet. Just beyond it, the nerve splits to supply the facing sides of those two toes — which is why removing it leaves that strip numb. Inset, a normal foot.

The small nerves that give feeling to the toes run forward between the long bones of the foot, and pass beneath a tight band of tissue that ties the ends of those bones together. Every step, and every narrow shoe, squeezes the nerve against that band.

What a picture cannot show is what happens next. Repeated squeezing makes the tissue around the nerve thicken, and a thicker nerve is squeezed harder still. That is why it tends to build up slowly, and why taking the pressure off early so often lets it settle.

It also explains the numbness after surgery. The nerve being removed is the one that gives feeling to the facing sides of two toes, so once it is gone that strip of skin stays numb. Most people barely notice it, but it is permanent.

How Morton's neuroma is assessed

Where exactly it hurts, and whether the burning or tingling runs into two particular toes
Pressing between the ends of the long foot bones to find the tender space
Squeezing the foot from side to side, which can produce a click — Mulder's click — and reproduce the pain
Checking the rest of the forefoot for bunions, hammertoes and joint inflammation, which often come with it
An X-ray to rule out a stress fracture or arthritis in the joints of the ball of the foot
Ultrasound where the diagnosis needs confirming; an MRI is rarely needed

Morton's neuroma treatment

Each step is tried before the next. The aim is to take the pressure off the nerve, and surgery is kept for when that is not enough.

Shoes and a pad

A shoe with a wide toe box and a low heel gives the bones room to spread. A small pad placed just behind the painful spot, not directly under it, lifts and separates the bones so the nerve is squeezed less. Many people need nothing more.

An injection

A steroid injection into the affected space, often guided by ultrasound, settles the irritation around the nerve. It helps some people for a long time and others only briefly, and it can be repeated, though not indefinitely.

Morton's neuroma surgery

When shoes and injections have not worked, the thickened nerve is usually removed through a small cut on the top of the foot. That space between the toes is then numb for good. In some cases the tight band over the nerve is released instead, which frees the nerve and keeps its feeling.

What recovery looks like

You walk in a protective shoe soon afterwards, and most people are back in ordinary shoes within a few weeks. Occasionally a painful nerve end forms at the site and the symptoms return, which is one reason surgery is kept for when the simpler steps have failed.

Your surgeon

Morton's neuroma here is seen by Dr Jeffrey Tan Gek Meng, a Senior Consultant Orthopaedic Surgeon whose subspecialty is foot and ankle, and the surgeon at this clinic who covers it. He is a Fellow of the Royal College of Surgeons of Edinburgh, completed his subspecialty fellowship in foot and ankle surgery at Toronto Western Hospital, and consults in English, Mandarin, Malay, Hokkien and Hainanese.

Foot and ankle is his subspecialty, so the ball of the foot is assessed alongside the bones and joints around it.
The whole forefoot is considered, because bunions and hammertoes — both part of his work — often come with a neuroma and change the plan.
Before private practice he was a Senior Consultant at Khoo Teck Puat Hospital, where he led the Foot and Ankle Division.
Surgery is not the default. Most people improve with shoes and a pad, and an operation is kept for when they do not.

When to see someone about it

Burning, tingling or numbness running into two toes
A feeling of a pebble or a folded sock under the ball of the foot
Pain that eases when you take your shoe off and rub the foot
Symptoms still there after a few weeks in wider, lower shoes
Sharp pain that worsens with each walk or run, which may be a stress fracture
Swelling on the top of the foot

Why see us about it

The simple steps first, because for many people they are all that is needed.
Straight talk about surgery, including the numbness it leaves.
A stress fracture ruled out, rather than assumed away.
Foot and ankle is a subspecialty here, for the forefoot as a whole.

Common questions

Is a Morton's neuroma a tumour?

No. Despite the name, it is a thickened, irritated nerve rather than a growth. It does not spread and is not cancerous; the thickening comes from the nerve being repeatedly squeezed.

Why does it feel like there is a pebble in my shoe?

The thickened nerve sits between the bones in the ball of the foot, so each step presses on it. That pressure is felt as a lump underfoot, even though there is nothing there to see.

Will it go away on its own?

It can settle once the pressure is taken off, particularly if it is caught early and you change to wider, lower shoes. If it has been there a long time, it is less likely to clear without further treatment.

Will my toes be numb after surgery?

If the nerve is removed, yes — the facing sides of the two toes it served stay numb permanently. Most people hardly notice it. Where the band over the nerve is released instead, feeling is kept.

Can it come back after surgery?

Occasionally. A painful nerve end can form where the nerve was cut, bringing the symptoms back. It is uncommon, and it is one reason surgery follows the simpler treatments rather than replacing them.

Do I need a referral to see a Morton's neuroma doctor?

No. Bring any foot X-rays or scan reports you have.

Related conditions

Foot pain · Bunions · Neuropathic pain