Morton’s neuroma is a painful condition affecting the ball of the foot, most commonly between the third and fourth toes. It occurs when a nerve that runs between the toes becomes thickened and irritated, leading to pain, burning, or a feeling like you’re standing on a pebble. The condition often develops gradually and may make walking or wearing tight shoes uncomfortable. In some cases, non-surgical treatments can relieve symptoms, but surgery may be necessary when pain persists.
How Common It Is and Who Gets It? (Epidemiology)
Morton’s neuroma most often affects adults, especially women who wear narrow or high-heeled shoes. These shoes place pressure on the front of the foot and squeeze the toes together. The condition is also more common in runners, people who spend long hours standing, and those with flat feet or high arches, which increase stress on the forefoot.
Why It Happens – Causes (Etiology and Pathophysiology)
The exact cause of Morton’s neuroma is not fully understood, but repeated compression and irritation of the nerve between the metatarsal bones are major factors. Constant pressure leads to inflammation and thickening around the nerve (perineural fibrosis). Contributing factors include tight footwear, high heels, high-impact activities, or foot mechanics such as overpronation, which increase strain on the nerve.
How the Body Part Normally Works? (Relevant Anatomy)
The affected structure is the common plantar digital nerve, which provides sensation to the toes. It runs between the metatarsal bones and passes under the deep transverse ligament in the ball of the foot. When this narrow space tightens due to pressure or swelling, the nerve becomes compressed, causing pain that radiates to the toes.
What You Might Feel – Symptoms (Clinical Presentation)
Typical symptoms include:
- Sharp, burning, or stabbing pain in the ball of the foot
- Numbness or tingling between the toes
- Cramping or a sensation of “walking on a pebble”
- Pain that worsens in tight shoes or during prolonged standing
- Temporary relief when removing shoes or massaging the foot
Symptoms usually progress over time, and pain may spread to nearby toes.
How Doctors Find the Problem? (Diagnosis and Imaging)
Doctors diagnose Morton’s neuroma primarily through a physical exam. Squeezing the forefoot may reproduce the pain or cause a “click” called Mulder’s sign. Imaging such as ultrasound or MRI may confirm nerve thickening or rule out other causes. X-rays can exclude bone problems but do not show the neuroma directly.
Classification
Morton’s neuroma is classified by its location and severity:
- Location: Most often between the third and fourth toes, but sometimes between the second and third.
- Severity: Mild, moderate, or severe, depending on pain intensity, frequency, and impact on function.
Multiple neuromas can occasionally occur in one foot.
Other Problems That Can Feel Similar (Differential Diagnosis)
Conditions that may mimic Morton’s neuroma include:
- Metatarsalgia (general forefoot pain)
- Capsulitis (joint capsule inflammation)
- Stress fracture of the metatarsal bones
- Arthritis in the toe joints
- Peripheral neuropathy from diabetes or other causes
A detailed exam and imaging help distinguish among these conditions.
Treatment Options
Non-Surgical Care
Most people improve with conservative measures, including:
- Wearing wide-toe-box shoes and avoiding high heels
- Padding or metatarsal pads to reduce pressure on the nerve
- Custom orthotics for alignment and cushioning
- Anti-inflammatory medications or corticosteroid injections for pain relief
- Physical therapy to correct foot mechanics and reduce nerve strain
Surgical Care
If non-surgical treatments fail, surgical excision (neurectomy) may be recommended. The surgeon removes the thickened portion of the nerve to relieve pain.
Two surgical approaches are used:
- Dorsal approach (top of the foot): Allows faster recovery with no scar on the sole.
- Plantar approach (bottom of the foot): Scar is less visible but recovery can take slightly longer.
Patients may have mild permanent numbness in the affected toes or, rarely, stump neuroma pain.
Recovery and What to Expect After Treatment
After surgery, a protective shoe or boot is worn for several weeks. Swelling and mild soreness are normal and improve with rest and elevation. Most people resume normal activities within four to six weeks, although full recovery may take a few months. Physical therapy can help restore flexibility and gait mechanics. The majority of patients report lasting pain relief.
Possible Risks or Side Effects (Complications)
Potential complications include:
- Infection or wound irritation
- Persistent or recurrent pain
- Numbness in the affected toes
- Scar tissue or stump neuroma formation
These issues are rare when surgery is performed by an experienced foot and ankle specialist.
Long-Term Outlook (Prognosis)
Most patients experience excellent long-term results. Both conservative and surgical treatments can relieve pain and restore comfort for walking and daily activities. Long-term studies show that most people maintain good to excellent outcomes years after surgery.
Out-of-Pocket Costs
Medicare
CPT Code 28080 – Excision of Morton’s Neuroma: $123.56
Supplemental Insurance (e.g., Medigap, AARP, Blue Cross Blue Shield) typically covers the 20% that Medicare does not pay. These plans are designed to fill the gap left by Medicare, ensuring that most patients incur little to no additional costs when the procedure is covered by Medicare. Supplemental plans work in tandem with Medicare and do not serve as a replacement.
Secondary Insurance (e.g., Employer-Based Plans, TRICARE, Veterans Health Administration) steps in as a secondary payer after Medicare has processed the claim. Once your deductible is met, secondary insurance may cover the remaining balance, including co-insurance. Some secondary plans do have deductibles, which can range from $100 to $300 depending on coverage specifics and whether the service is provided in-network or out-of-network.
Workers’ Compensation
If your excision of Morton’s neuroma is related to a work injury, Workers’ Compensation will cover all surgery and recovery costs, leaving you with no out-of-pocket expenses.
No-Fault Insurance
If your procedure is the result of an automobile accident, No-Fault Insurance will cover the full cost, except for a minor deductible, which depends on the terms of your policy.
Example:
Susan needed excision of Morton’s neuroma due to persistent foot pain. With Medicare, her estimated out-of-pocket cost was about $123.56. However, because Susan had secondary insurance, the remaining 20% was covered, leaving her with no additional costs.
Frequently Asked Questions (FAQ)
Q. What is Morton’s Neuroma?
A. Morton’s neuroma is a painful condition affecting the ball of the foot, often between the third and fourth toes, where a thickening of tissue forms around a nerve leading to the toes, causing pain, burning sensations, and a lump feeling.
Q. How is Morton’s Neuroma treated surgically?
A. Excision of Morton’s neuroma involves removing the affected nerve to alleviate pain. This can be done through a dorsal or plantar approach, with the choice depending on the patient’s needs and the surgeon’s recommendation.
Q. What is the difference between the dorsal and plantar approaches for Morton’s neuroma excision?
A. The dorsal approach involves an incision on top of the foot, while the plantar approach is on the bottom of the foot. The plantar approach is often preferred for its cosmetic benefits and lower complication rates.
Q. What is the recovery time after Morton’s neuroma excision surgery?
A. Recovery typically involves significant pain relief within weeks of the procedure, with some swelling and discomfort in the first few days. Physical therapy may be recommended to help regain strength and mobility.
Q. What are the potential risks of Morton’s neuroma excision surgery?
A. Risks include infection, recurrence of the neuroma, numbness in the affected toes, and the formation of scar tissue, though these complications are rare and manageable with proper care.
Q. How effective is Morton’s neuroma excision surgery?
A. The surgery has a high success rate, with many patients reporting significant pain relief and improvement in foot function. However, some may experience mild ongoing numbness or foot sensitivity.
Q. Can Morton’s neuroma excision be performed on both feet at the same time?
A. While it is possible to perform the procedure on both feet, it is typically done one foot at a time to ensure proper healing and reduce the risk of complications.
Q. Will I need to wear a special shoe after Morton’s neuroma excision surgery?
A. Yes, you will likely need to wear a special post-surgical shoe or boot to protect the foot and allow proper healing after the surgery.
Q. Is Morton’s neuroma excision surgery suitable for everyone with the condition?
A. Excision surgery is recommended for patients with persistent pain or symptoms despite conservative treatments like physical therapy or changes in footwear, and when the neuroma is large or causing significant issues.
Q. How soon can I return to normal activities after Morton’s neuroma excision surgery?
A. Most patients can return to normal activities within 6 to 8 weeks, though high-impact activities should be avoided until the foot has fully healed.
Q. Can Morton’s neuroma excision surgery be performed on both feet simultaneously?
A. It is generally recommended to perform the surgery on one foot at a time to allow for proper healing and reduce the risk of complications, though it is possible to treat both feet if necessary.
Q. What should I expect during the first few days after Morton’s neuroma excision surgery?
A. In the first few days, you may experience swelling, bruising, and discomfort around the incision site. Pain can usually be managed with prescribed medications, and elevating the foot can help reduce swelling.
Q. Will I have any numbness after Morton’s neuroma excision surgery?
A. Some patients may experience temporary or permanent numbness in the toes or the ball of the foot, as the surgery involves cutting the nerve. This is usually mild but can vary depending on the extent of the excision.
Q. Are there any alternatives to surgery for treating Morton’s neuroma?
A. Non-surgical treatments include wearing custom orthotics, using corticosteroid injections, physical therapy, and modifying footwear. These may provide relief for some patients, but surgery is recommended for those with severe or persistent symptoms.
Q. How long does the Morton’s neuroma excision procedure take?
A. The procedure typically takes 30 to 60 minutes, depending on the complexity of the neuroma and the surgical approach used.
Q. Can Morton’s neuroma excision be done as an outpatient procedure?
A. Yes, Morton’s neuroma excision is typically performed on an outpatient basis, meaning patients can go home the same day after the surgery, though they will need someone to drive them home.
Q. Will I need physical therapy after Morton’s neuroma excision surgery?
A. Physical therapy is usually not required after Morton’s neuroma excision, but some patients may benefit from exercises to help restore strength and flexibility in the foot, depending on their recovery progress.
Q. Is surgery always necessary?
A. No. Many people improve with shoe changes, padding, or injections.
Q. Can the neuroma come back?
A. Recurrence is uncommon but possible if nerve irritation continues or if scar tissue develops.
Q. Will I lose feeling in my toes?
A. Mild numbness is expected but usually not bothersome.
Q. When can I walk normally again?
A. Most patients return to regular shoes within four to six weeks.
Q. Can both feet be treated?
A. Yes, but surgery is usually done on one foot at a time to ensure proper healing.
Summary and Takeaway
Morton’s neuroma causes painful thickening of a nerve in the ball of the foot, most often between the third and fourth toes. It commonly affects women and people who wear tight or high-heeled shoes. Conservative treatments such as wider footwear, orthotics, and injections help many patients. When these fail, surgical removal of the neuroma provides long-term pain relief and restores function.
Clinical Insight & Recent Findings
Recent research has explored minimally invasive treatments for Morton’s neuroma. In one study, a young nurse with severe pain that did not respond to medications or injections underwent ultrasound-guided pulsed radiofrequency (PRF) treatment. This technique delivers brief bursts of electrical energy to calm the nerve without damaging it.
Within one month, her pain score dropped dramatically—from 9 out of 10 to 1 out of 10—and she regained full function.
The researchers found that PRF can be a safe, effective alternative to surgery for patients who do not respond to conservative care. It provides durable relief with a very low risk of numbness or scar formation. (Study on pulsed radiofrequency treatment for Morton’s neuroma – see PubMed.)
Who Performs This Treatment? (Specialists and Team Involved)
Treatment is managed by orthopedic foot and ankle surgeons or podiatrists. The surgical team may include an anesthesiologist and a physical therapist to assist with pain management and rehabilitation.
When to See a Specialist?
You should see a specialist if pain, burning, or tingling between your toes persists for several weeks despite shoe modifications or padding. Early diagnosis often prevents the need for surgery.
When to Go to the Emergency Room?
Seek emergency care for sudden, severe forefoot pain, swelling, or numbness after an injury, or if signs of infection such as redness or fever appear.
What Recovery Really Looks Like?
Recovery is gradual but predictable. Soreness and mild swelling are common in the first few weeks. Walking in a surgical shoe for two to four weeks is typical, followed by a return to regular footwear. Most people regain comfort and mobility within two to three months.
What Happens If You Ignore It?
Untreated Morton’s neuroma can lead to chronic pain, nerve scarring, and difficulty walking or wearing shoes comfortably. Over time, compensating for the pain can cause additional strain on other parts of the foot.
How to Prevent It?
- Wear shoes with a wide toe box
- Avoid high heels or narrow footwear
- Use metatarsal pads to distribute pressure evenly
- Stretch the feet and calves regularly
- Address early symptoms promptly to prevent nerve damage
Nutrition and Bone or Joint Health
A healthy diet rich in calcium, vitamin D, and protein supports bone and nerve function. Staying hydrated and maintaining a healthy body weight reduce stress on the feet and promote healing after treatment or surgery.
Activity and Lifestyle Modifications
After treatment, resume activity gradually and choose low-impact exercises such as cycling, swimming, or yoga. Wear cushioned, supportive shoes and avoid prolonged standing or tight footwear that puts pressure on the ball of the foot.
Dr. Mo Athar
