Key clinical summary
Morton’s neuroma is a focal interdigital nerve irritation problem that usually causes burning forefoot pain, numbness or a stone-in-the-shoe feeling between the toes.
- Symptoms often worsen in narrower footwear or with longer periods on the forefoot.
- Pain may be accompanied by tingling, altered sensation or a clicking sensation rather than swelling.
- Ultrasound is useful because it can show the neuroma and help target injection if conservative care has not been enough.
Typical presentation
People often describe sharp or burning pain in the ball of the foot, tingling into the toes, a sensation of standing on a pebble, or the need to remove a shoe and rub the forefoot.
Some patients mainly notice numbness and altered sensation, whereas others experience intermittent severe zapping pain.
Why it happens
The interdigital nerve can become repeatedly compressed and irritated between adjacent metatarsal heads and surrounding soft tissue. Narrow footwear, local forefoot overload and altered pressure patterns can all contribute.
The condition is not always a simple “lump”. It is better understood as a localised nerve irritation problem.
Assessment and differential diagnosis
Assessment should identify exactly where forefoot symptoms sit, what footwear aggravates them, whether numbness is present and whether the patient can reproduce symptoms with forefoot squeeze or toe loading.
A clear diagnosis matters because treatment changes significantly depending on whether the main issue is nerve irritation, overload beneath the metatarsal heads or a stress-related process.
Where ultrasound helps
Ultrasound is particularly useful for Morton’s neuroma because it can visualise the interdigital neuroma and help distinguish it from neighbouring bursitis or joint-related forefoot pain.
It also assists with precise needle placement if an injection is chosen.
Treatment strategy
Conservative treatment usually starts with wider footwear, reduced forefoot compression, simple orthotic or metatarsal dome strategies and activity modification where needed.
If pain remains intrusive, ultrasound-guided injection may be discussed. The aim is to reduce nerve irritation while continuing to manage footwear and loading.
Evidence strength summary
Strongest support
Diagnosis-led rehabilitation, sensible load management and clear progression remain the most reliable foundation of care.
Where ultrasound adds value
Ultrasound is most helpful when the result changes treatment, improves diagnostic confidence or supports precise needle placement.
Where injections fit
Injections should support a wider plan rather than stand in for rehabilitation, support or activity modification.
Page-specific FAQs
Does Morton’s neuroma always cause numbness?
Not always. Some people mainly feel burning or a pebble-under-the-foot sensation rather than obvious numbness.
Can a neuroma settle without surgery?
Yes, many patients improve with wider footwear, forefoot load modification and, in selected cases, ultrasound-guided injection.
Why does taking my shoe off sometimes help straight away?
Reducing compression across the forefoot can decrease pressure on the irritated interdigital nerve.
Is ultrasound better than guessing with an injection?
It is usually more helpful because it confirms the neuroma’s location and improves targeting accuracy.
When should stress fracture be ruled out instead?
If pain is more bony, more constant, associated with impact spikes or local swelling, a stress-related diagnosis should be considered.
Ready for a clearer diagnosis and treatment plan?
Book a specialist assessment, explore the patient hub or review injection options before you decide.
Harvard references
- Thomson, C.E., Gibson, J.N.A. and Martin, D. (2004) Interventions for the treatment of Morton’s neuroma. Cochrane Database of Systematic Reviews, CD003118.
- Sharp, R.J. et al. (2003) The role of MRI and ultrasound imaging in Morton’s neuroma. Journal of Bone and Joint Surgery British, 85(7), pp.999–1005.
- Mahadevan, D. et al. (2015) Ultrasound-guided corticosteroid injection in Morton’s neuroma. Foot & Ankle International, 36(7), pp.790–797.
What to do next
If symptoms are persistent, worsening or stopping you from walking, training or sleeping normally, the next useful step is a proper assessment rather than more guesswork. At Wellbeing & Health MSK Clinics the pathway combines clinical examination, diagnostic ultrasound where it genuinely adds value, and a treatment plan that matches the problem rather than forcing every foot and ankle issue into the same template.
Most patients choose a same-visit diagnostic pathway
For suitable cases we can assess, explain the likely diagnosis, use ultrasound where it adds value, and discuss whether rehabilitation alone or rehabilitation plus a guided injection is the most sensible next step.