In New Zealand, morton's Neuroma is managed by podiatrys. Morton's neuroma is a painful thickening of one of the small nerves that runs between the toes, most often the nerve in the third web space between the third and fourth toes. The lesion is not a true tumour but a benign perineural fibrosis caused by repeated compression of the common plantar digital nerve against the deep transverse metatarsal ligament.
Morton's neuroma (ICD-10: G57.6, lesion of the plantar nerve) is a benign mechanical neuropathy of a common plantar digital nerve at the level of the metatarsal heads. Despite the historical name, it is not a neoplasm. The lesion is a fusiform thickening of the nerve with perineural fibrosis, endoneurial oedema, demyelination, and Renaut-body formation, caused by repetitive entrapment of the nerve between the deep transverse intermetatarsal ligament dorsally and the metatarsal heads plantarly during toe extension. The third web space (between the third and fourth metatarsal heads) is involved in roughly 60-85% of symptomatic cases because the medial and lateral plantar nerves both contribute branches there, producing a thicker, more vulnerable common digital nerve.
The key symptoms of Morton's Neuroma are: Burning, sharp, or electric-shock pain in the ball of the foot, usually between the third and fourth toes, brought on by walking and relieved within minutes of taking the shoe off., Sensation of standing on a small pebble, a folded sock seam, or a marble inside the shoe — a near-pathognomonic descriptor reported by roughly two-thirds of patients., Numbness, tingling, or 'pins and needles' radiating into the two toes adjacent to the affected web space (most often the third and fourth)., Pain reproducibly triggered by narrow, high-heeled, or pointed shoes and relieved by removing the shoe and massaging the forefoot., A palpable click felt by the examining clinician during Mulder's manoeuvre (mediolateral squeeze of the metatarsal heads while the affected web space is compressed) — present in 60-95% of cases., Forefoot pain that worsens with prolonged standing, walking on hard surfaces, running, dancing, or climbing stairs and that eases with rest., Cramping or 'gripping' sensation in the forefoot during activity, often described as the toes wanting to claw..
Morton's neuroma is a clinical diagnosis in most patients. A focused history — burning forefoot pain on walking, the 'pebble in the shoe' sensation, and relief on removing footwear — combined with reproducible tenderness on plantar palpation of the affected web space and a positive Mulder's click test is sufficient to make the diagnosis in roughly 85-90% of cases. Mulder's manoeuvre is performed by squeezing the metatarsal heads together with one hand while the examiner's other thumb and index finger compress the suspected web space; a palpable click with pain reproduces the symptom and has a reported sensitivity of 60-95% and specificity of 70-100% depending on operator experience. Plain X-rays are normal in pure neuroma but are routinely obtained on weight-bearing views to exclude metatarsal stress fracture, MTP joint arthritis, and Freiberg's infraction, and to identify a long second metatarsal or hallux valgus that may be driving the mechanics. High-resolution ultrasound is the first-line imaging investigation when diagnosis is unclear or surgery is being considered; in trained hands it shows a hypoechoic, ovoid intermetatarsal mass with sensitivity around 85-100% and specificity 50-83% for lesions over 5 mm. MRI is reserved for atypical presentations, suspected co-existing pathology (plantar plate tear, ganglion, capsulitis), or planning revision surgery after a failed neurectomy. Reported MRI sensitivity is 87-100% with similar specificity. Differential diagnosis is the central diagnostic skill: metatarsalgia, MTP synovitis or plantar plate tear, stress fracture, tarsal tunnel syndrome with medial plantar branch involvement, and lumbar radiculopathy (L5 or S1) all produce overlapping forefoot pain and require structured exclusion.
Most patients with Morton's neuroma do well with non-operative care. Roughly 30-50% achieve durable symptom relief through shoe change, metatarsal padding, and activity modification alone within 3 months. Adding ultrasound-guided corticosteroid injection brings another 20-30% of patients into the durable-relief group at 12 months. Of those who proceed to surgery after failed conservative care, 75-85% report good or excellent results at 5-10 years (Kasparek 2013), with the trade-off of permanent numbness between the affected toes. Recurrent or stump neuroma occurs in 4-10% of operated patients and is the dominant reason for ongoing or returning pain. Predictors of poorer outcome are larger lesions on imaging, longer duration of symptoms before treatment, simultaneous neuromas in two web spaces, and co-existing forefoot deformity that is not corrected. The condition does not shorten life expectancy and does not progress to systemic disease — the long-term concern is forefoot pain and footwear restriction rather than damage to the broader nervous system.
Refer to a podiatrist or foot-and-ankle orthopaedic surgeon when forefoot pain persists for more than 6-8 weeks despite consistent shoe change and over-the-counter metatarsal pads, when there is diagnostic uncertainty (especially possible plantar plate tear, stress fracture, or MTP synovitis), when an ultrasound-guided injection or surgery is being considered, or when symptoms recur after previous surgery. Diabetics and patients with peripheral vascular disease should be seen earlier because of the higher complication rate of injection and surgery in those groups.
Find specialists →Conservative measures act over weeks rather than days. Shoe change and metatarsal padding take 4-12 weeks to reach peak effect. A corticosteroid injection typically relieves pain within 3-7 days, peaks at 2-4 weeks, and may last from 6 weeks to many months. Surgical recovery is faster than patients expect: after dorsal neurectomy most patients walk with a stiff-soled post-operative shoe within 24 hours, transition to regular footwear at 3-4 weeks, and return to most daily activities by 6-8 weeks. Running, dancing, and high-impact sports are usually possible from 8-12 weeks. Numbness between the operated toes is permanent but most patients adapt within 3-6 months.
Most people with Morton's neuroma can continue moderate exercise with sensible substitution. Replace running and high-impact court sports with cycling, swimming, elliptical training, or rowing during symptom flares. Calf and Achilles stretching for 2-3 minutes twice daily, toe spreads (10 repetitions, three times daily), and towel scrunches build the intrinsic foot muscles that protect the metatarsal arch. When returning to running, build mileage by no more than 10% per week and run on softer surfaces such as grass or rubberised tracks. Dancers should reduce time en pointe during flares and use lambs-wool or gel forefoot padding inside pointe shoes.
For non-surgical care, look for a podiatrist with experience in ultrasound-guided forefoot injections and orthotic prescribing. For surgical care, look for a fellowship-trained foot-and-ankle orthopaedic surgeon or podiatric surgeon whose practice includes regular forefoot work, with documented case volumes and revision experience for failed primary surgery. Ask specifically about their preferred surgical approach (dorsal versus plantar), their rate of recurrent neuroma, and their pre-operative discussion of permanent numbness — these are markers of an experienced practice.
Medically reviewed by AIHealz Medical Editorial Board · May 12, 2026
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