At a glance
Main symptoms
- Burning, stinging pain between toes in the forefoot
- Sometimes "rock in my shoe" sensation
- Pain sometimes radiates to toes
- Hospital stay
- No hospital stay needed, same-day discharge.
- Recovery time
- 4–6 weeks
- Return to work
- Desk work in 3-7 days, standing jobs in 2-3 weeks, heavy work or athletes in 4-6 weeks.
Morton's neuroma is thickening of the interdigital nerve between toes in the forefoot. It is most commonly seen between the 3rd and 4th toes. Not a true tumor; rather a reactive thickening from chronic compression. Narrow-toe shoes, high heels, and foot deformities (e.g., flat foot) are risk factors. 40-60 year old women are affected 8-10 times more often.
Symptoms
Characteristic complaints:
- Burning, stinging pain between toes in the forefoot
- Sometimes "rock in my shoe" sensation
- Pain sometimes radiates to toes
- Relief by removing shoe and massaging foot
- Numbness or sensation change between 3rd and 4th toes
- Worsens with walking, especially with narrow or high-heeled shoes
Diagnostic Methods
Clinical examination is usually sufficient for diagnosis. The Mulder test (compressing between toes producing a "click") is characteristic of Morton's neuroma. Ultrasound is the first choice showing neuroma size and location. MRI is used for unclear cases. X-rays evaluate accompanying foot deformities.
Treatment Approach
Non-Surgical Treatments
First-line treatment is always conservative: wide-toe, low-heeled shoes, orthopedic insoles (metatarsal pad), NSAIDs, physical therapy, and when needed ultrasound-guided cortisone injection (long-term relief in 60-80% of cases). If insufficient over 6 months, surgery is considered.
Surgical Treatment
Surgical options: neuroma excision (removing the thickened nerve — most common), neurolysis (nerve release), in selected cases radiofrequency ablation or alcohol injection. After excision, permanent numbness remains in the relevant toe spaces; this is expected and generally tolerated.
Surgical Process
Performed under local or regional anesthesia. Procedure lasts 30-45 minutes. A small incision on dorsal foot or sole removes the neuroma.
Hospital Stay
No hospital stay needed, same-day discharge.
Recovery Process
- Weeks 1-2: Walking with special shoe or sandal, weight on heel
- Weeks 2-3: Suture removal, transition to normal shoe
- Weeks 3-6: Active walking, gradual activity
- Weeks 6-12: Full activity, running/sports
Return to Work
Desk work in 3-7 days, standing jobs in 2-3 weeks, heavy work or athletes in 4-6 weeks.
Potential Complications
Surgical success rate is 80-90%. Complications: stump neuroma (new neuroma at cut nerve end — 5%), infection, wound healing problems, permanent numbness (expected), rare recurrence.
Frequently asked questions
What shoes should I wear?
Wide-toe, low-heel (under 1 inch), well-cushioned shoes. High-heeled, narrow-toe models worsen symptoms.
Is cortisone a permanent solution?
No, but provides months/years of relief in 60-80% of cases. No more than 2-3 injections are recommended.
Will numbness remain after surgery?
Yes, a permanent numb area in the relevant toe spaces. Most patients don't mind because pain is relieved.
This content is for information only and does not replace examination, diagnosis or treatment. The right treatment for you is decided after an examination.