Morton's Neuroma and Forefoot Pain
Morton’s neuroma is a common cause of pain in the ball of the foot. It can cause burning, shooting or sharp pain, tingling or numbness into the toes, and sometimes the sensation that there is a pebble or lump inside your shoe.
Although it is commonly called a “neuroma”, Morton’s neuroma is not a nerve tumour. It involves irritation and thickening of tissue around one of the nerves that runs between the metatarsal bones of the forefoot.
At MK Orthotics in Milton Keynes, we assess the foot and lower-limb mechanics that may be contributing to your symptoms, rather than assuming that an orthotic is automatically the answer.
What is Morton’s neuroma?
Morton’s neuroma, also known as interdigital neuralgia, affects one of the nerves running between the metatarsal bones towards the toes.
The nerve is commonly irritated where it passes between the metatarsal heads. Repeated pressure or compression can irritate the nerve and the surrounding tissues, producing pain and altered sensation.
Morton’s neuroma most commonly affects the space between the third and fourth toes, although it can occur between other toes as well.
What does Morton’s neuroma feel like?
Symptoms can vary, but typical symptoms include:
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Burning or sharp pain in the ball of the foot
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Shooting or electric-shock-like pain into the toes
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Tingling or pins and needles
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Numbness in the toes
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Pain between or around two adjacent toes
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A feeling that there is a pebble, stone or lump inside your shoe
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Symptoms that become worse when walking or standing
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Symptoms that are aggravated by tight or narrow footwear
Some people find that removing their shoe or stopping the activity provides relief.
As the nerve becomes increasingly irritated, symptoms can sometimes occur with less activity or even when the foot is not weight-bearing.
Where does Morton’s neuroma cause pain?
The pain is usually felt in the forefoot or ball of the foot, often between the third and fourth toes.
You may also feel symptoms extending into the adjacent toes. Some people describe pain on one side of one toe and the adjacent side of the next toe.
The exact location is useful when assessing forefoot pain because several different conditions can produce similar symptoms.
What causes Morton’s neuroma?
There is not always one clear cause.
The nerve can become irritated by repeated loading or compression in the forefoot. Footwear can be an important aggravating factor, particularly shoes that are narrow around the toes, have high heels or have thin, hard soles. These can increase pressure around the ball of the foot.
Morton’s neuroma can also be associated with other foot problems, including:
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Flat feet or changes in foot posture
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High arches
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Bunions
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Lesser toe deformities
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Activities involving repetitive forefoot loading
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Footwear that restricts the toes
This does not mean that having one of these features will cause Morton’s neuroma. The important question is whether the way your foot moves and loads during standing and walking is contributing to your symptoms.
Is Morton’s neuroma the same as metatarsalgia?
No.
Metatarsalgia is a general term for pain in the ball of the foot. Morton’s neuroma is one possible cause of forefoot pain.
Morton’s neuroma is more suggestive when symptoms include burning, shooting or electric pain, tingling or numbness extending towards the toes, particularly when symptoms are aggravated by footwear or pressure around the forefoot.
Other causes of forefoot pain can include joint or soft-tissue problems, stress injuries and mechanical overload. If the cause of your symptoms is unclear, an assessment can help determine what may be contributing.
Read more about: Metatarsalgia
Can foot mechanics contribute to Morton’s neuroma?
The way the foot and lower limb move can influence how forces are distributed through the forefoot.
This does not mean that there is one particular foot shape or walking pattern that causes Morton’s neuroma. Instead, we look at the whole picture, including:
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Foot posture
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How the foot moves during walking
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Forefoot loading
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Ankle movement
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Lower-limb alignment
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Muscle strength and control
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Footwear
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Your activities and training
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Where and when your symptoms occur
For some people, reducing pressure around the affected area may be an important part of managing symptoms.
Can orthotics help Morton’s neuroma?
Sometimes, but not everyone with Morton’s neuroma needs an orthotic.
The aim of an orthotic intervention is not simply to “correct” your foot. Depending on your individual assessment, an orthotic or forefoot offloading strategy may be used to help redistribute pressure away from the painful area.
This may involve an appropriate metatarsal pad, dome or an orthotic designed around your individual foot and movement pattern. Footwear is also an important part of the treatment approach. Wider, comfortable footwear with adequate space around the toes can reduce pressure on the forefoot.
The important question is whether an orthotic is likely to help your particular symptoms and mechanics.
That is why we assess before recommending an orthotic rather than assuming that one is required.
What happens during an MK Orthotics assessment?
At MK Orthotics, the assessment is designed to understand why you are experiencing your symptoms, not simply to identify a foot shape.
Your assessment may include:
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A detailed discussion of your symptoms and activities
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Assessment of foot posture and function
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Assessment of ankle and foot movement
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Assessment of lower-limb alignment
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Functional movement assessment
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Assessment of how you load the foot
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Video gait analysis where appropriate
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Assessment of your current footwear
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Review of any previous orthotics or insoles you have used
Our assessment takes approximately 90 minutes, allowing time to look at the relationship between your symptoms, foot mechanics and lower-limb function.
If an orthotic intervention is appropriate, we can then consider what type of device and design is most suitable.
I've already tried orthotics and they didn't work
If you've previously tried insoles or orthotics without success, that does not necessarily mean that orthotics cannot help.
It is important to understand:
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What the previous orthotic was designed to do
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How it was fitted
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Whether it changed the loading pattern you were trying to address
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Whether it was comfortable
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What footwear you were using
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Whether the original diagnosis was correct
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Whether your symptoms have changed
If you have previous orthotics, bring them with you to your assessment. They can provide useful information about what has already been tried.
What can I do myself for Morton’s neuroma?
Footwear is often an important starting point.
Shoes with a wide, comfortable toe area, low heel and appropriate cushioning may reduce pressure on the forefoot. Tight, narrow or high-heeled shoes can aggravate symptoms.
Depending on your symptoms, temporary activity modification and an appropriate pad or insole may also help.
If your pain is persistent, worsening or associated with significant numbness or tingling, it is sensible to have the diagnosis assessed rather than continuing to treat the symptoms yourself. NHS guidance recommends seeking assessment when foot pain is severe, worsening, recurrent, affecting normal activities, or associated with neurological symptoms such as numbness or weakness.
Do I need a scan for Morton’s neuroma?
Not necessarily.
Morton’s neuroma can often be diagnosed clinically from the history and physical examination. Ultrasound may sometimes be used to investigate the soft tissues or help when the diagnosis is uncertain. MRI is less commonly required.
If your symptoms do not fit the typical pattern of Morton’s neuroma, or if there are other features that need investigation, further medical assessment may be appropriate.
When should I have Morton’s neuroma assessed?
Consider having your symptoms assessed if:
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Forefoot pain is affecting your walking or activities
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You have persistent burning or shooting pain
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You experience numbness or tingling in your toes
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Symptoms keep returning
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You have tried changing footwear without sufficient improvement
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You have already tried insoles or orthotics without success
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You are unsure whether your symptoms are actually caused by Morton’s neuroma
A proper assessment can help establish whether Morton’s neuroma is a likely explanation for your symptoms and whether an orthotic approach is appropriate.
Morton’s neuroma and foot pain in Milton Keynes
If you have persistent forefoot pain, burning or tingling in your toes, or the feeling that there is a pebble in your shoe, MK Orthotics can assess your foot and lower-limb mechanics in Milton Keynes.
We don't prescribe orthotics simply because someone has a diagnosis of Morton’s neuroma. We first assess your symptoms, movement and loading pattern to determine whether an orthotic intervention is appropriate and what it would be intended to achieve.
If orthotics are unlikely to address the underlying problem, we will explain this rather than recommend an unnecessary device.
Related conditions
Forefoot symptoms can overlap with a number of other foot and lower-limb conditions.
You may also find these pages useful:
Morton’s neuroma causing you problems?
If forefoot pain, burning, tingling or numbness is affecting your walking, exercise or everyday activities, an assessment can help establish what may be contributing to your symptoms.
Book a 90-minute biomechanical assessment with MK Orthotics in Milton Keynes.
MK Orthotics is based in Blakelands, Milton Keynes.