You take off your shoe and shake it out, but nothing falls out. Yet every step still feels like you're walking on a small stone or a bunched-up sock. If that sounds familiar, the cause may not be in your shoe at all. It may be an irritated nerve in the ball of your foot, a condition called Morton's neuroma.

This guide explains what Morton's neuroma is, why it happens, how it's evaluated, and the kinds of care a podiatrist may talk through with you.

What Is Morton's Neuroma?

Despite the name, a Morton's neuroma is not a true tumor. The American Academy of Orthopaedic Surgeons describes it as "a thickening of the tissue surrounding one or more small nerves leading to the toes."2 Cleveland Clinic calls it "thickening in your existing nerve tissue."3

It most often develops in the ball of the foot, between the third and fourth toes.1,3 According to the American College of Foot and Ankle Surgeons (ACFAS), the nerve enlarges when it's compressed and irritated, and over time this can lead to permanent nerve damage.1

What Does It Feel Like?

The classic description is the feeling of stepping on something. Cleveland Clinic says it can feel like "a marble, small rock, or bunched sock."3 AAOS describes the sensation of "walking on a marble."2 Other common symptoms include:1,2,3

  • Sharp, stinging or burning pain in the ball of the foot, which may spread into the toes
  • Tingling or numbness in the toes
  • Pain that gets worse when you stand, walk or push off from the front of your foot
  • Pain that flares in high heels or tight, narrow shoes

Symptoms usually start slowly. ACFAS notes they may first show up only during certain activities or in certain shoes, then get worse over time as the neuroma enlarges.1

What Causes It?

Experts don't know the exact cause. AAOS says research suggests it is likely the result of the nerve being compressed or squeezed, which may trigger swelling and abnormal tissue around the nerve.2 ACFAS puts it simply: "anything that causes compression or irritation of the nerve" can lead to a neuroma.1

Can My Shoes Cause Morton's Neuroma?

Footwear is one of the most common factors. ACFAS names shoes with a tapered toe box and high heels that force the toes forward as frequent offenders.1 Other risk factors include:1,2,3

  • Foot shape: bunions, hammertoes, flat feet, high arches or more flexible feet
  • Repetitive activity: running or court sports such as tennis that put pressure on the ball of the foot
  • Long hours on your feet for work
  • A past injury to the foot

AAOS reports that Morton's neuroma is about eight times more common in women than in men, and that it usually affects people between ages 30 and 60.2 If you have bunions or other forefoot problems, it's worth mentioning any toe numbness or burning at your visit.

How Is Morton's Neuroma Evaluated?

There's no single at-home test. A foot specialist usually starts with your history and an exam:1,2,3

  • Questions about your symptoms, your shoes and your activities.
  • Pressing on the spaces between the toes. AAOS notes that squeezing the web space "often re-creates the pain."2
  • Imaging when needed. X-rays can't show a neuroma, but they can help rule out other causes of forefoot pain.3 AAOS lists ultrasound as the preferred imaging method,2 and Cleveland Clinic notes that ultrasound or an electromyography (nerve) test may be used.3
  • A numbing injection is sometimes used to help confirm the diagnosis. If the pain goes away after the area is numbed, that points toward a neuroma.2

ACFAS emphasizes that early diagnosis "greatly lessens the need for more invasive treatments."1 So it's better not to wait it out for months.

What Can I Do About It? Conservative Care

Most care starts with simple, nonsurgical steps. Depending on your situation, a podiatrist may discuss:1,2,3

  • Changing your shoes. Choose wider shoes with a roomy toe box and lower heels, and avoid tight, narrow or high-heeled styles.
  • Padding. Metatarsal pads can take pressure off the nerve.
  • Custom orthotics, or shoe inserts made for your feet.
  • Ice to help ease swelling.
  • Over-the-counter anti-inflammatory medicine such as ibuprofen.
  • Activity changes, such as easing up on activities that load the ball of the foot.
  • Injections. A corticosteroid (cortisone) injection may be used to reduce swelling and pain.

AAOS says many people "can achieve long-term relief" with a combination of shoe changes, orthotics, anti-inflammatory medicine and/or corticosteroid injections.2 Results vary from person to person, though.

A note on the research: the evidence for nonsurgical treatments is still limited. A 2019 systematic review found that corticosteroid injections and manipulation/mobilisation had the strongest evidence for reducing pain, but it did not find high-quality evidence for any single "gold standard" treatment. The authors called for more well-designed trials.4

When Are Other Treatments Considered?

If symptoms don't improve with conservative care, other options may come up. AAOS describes procedures that target the nerve, such as alcohol injections, radiofrequency ablation and cryoablation (freezing).2 The 2019 review notes that these have mostly been studied in case series of limited quality, so their results should be read with caution.4

Surgery is generally considered when nonsurgical care hasn't helped enough. AAOS suggests it may be recommended if symptoms last beyond three to six months.2 The two main approaches are releasing the tissue around the nerve to take pressure off it, or removing the affected portion of the nerve.2 ACFAS notes that recovery time varies with the type of procedure.1 Cleveland Clinic and AAOS both note that symptoms can come back for some people, even after treatment.2,3

Every option has trade-offs, and the right path depends on your foot, your symptoms and your goals. That's a conversation to have with a podiatrist in person.

When Should I See a Podiatrist?

Cleveland Clinic suggests seeing a provider if foot pain lasts more than two weeks, gets worse, gets in the way of daily activities, or comes with tingling or numbness.3 Burning or numbness in the forefoot can have other causes too, so an exam matters. If you have diabetes, learn more about diabetic foot care.

To talk with someone about your symptoms, call Butte & Anaconda at (406) 782-2278 or Bozeman, Ennis & Harlowton at (406) 587-8478. For sudden, severe pain, signs of infection or an injury, call the clinic or seek emergency care.

The Bottom Line

Morton's neuroma is a thickened, irritated nerve in the ball of the foot, most often between the third and fourth toes. It can feel like a pebble in your shoe, along with burning, tingling or numbness. Tight, narrow and high-heeled shoes are common triggers. Care usually starts with roomier shoes, padding and other conservative steps, with other treatments considered if those don't help enough. Getting it checked early can make a difference.

If your forefoot pain isn't going away, our podiatrists can take a look. Request an appointment and our team will follow up within one business day. You can also find your nearest office on our locations page.

This article is for general education and isn't a substitute for medical advice. Talk with a podiatrist or your doctor about your own symptoms.

Sources

  1. Morton's Neuroma. American College of Foot and Ankle Surgeons (FootHealthFacts.org). www.foothealthfacts.org
  2. Morton's Neuroma. American Academy of Orthopaedic Surgeons, OrthoInfo. www.orthoinfo.org
  3. Morton's Neuroma: Causes, Symptoms & Treatment. Cleveland Clinic. my.clevelandclinic.org
  4. Matthews BG, Hurn SE, Harding MP, Henry RA, Ware RS. The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Morton's neuroma): a systematic review and meta-analysis. Journal of Foot and Ankle Research, 2019. pmc.ncbi.nlm.nih.gov