Mortons neuroma

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Expert Patient Guide  ·  London

Morton’s Neuroma Treatment in London — Forefoot Nerve Pain Specialist

A comprehensive patient guide by Mr Matthew Welck — Consultant Orthopaedic Foot and Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore and UCL, treating patients across London, North London, and Hertfordshire.

At a Glance: Morton’s Neuroma

ConditionMorton’s neuroma — a painful thickening of the interdigital plantar nerve in the front of the foot, most often between the third and fourth toes.
UK PrevalenceSymptomatic forefoot neuromas affect an estimated 3–5 in every 100 adults; women are affected up to 8–10 times more often than men.
Most Common CauseMechanical irritation of the nerve from tight or narrow footwear, high heels, repetitive forefoot loading, and underlying foot shape.
DiagnosisClinical examination including Mulder’s click test, with high-resolution ultrasound and/or MRI to confirm and size the lesion.
Non-Surgical CareFootwear advice, metatarsal pads, custom orthoses, physiotherapy, NSAIDs, ultrasound-guided steroid injection.
Surgical OptionsNeurectomy (dorsal or plantar approach) and nerve decompression. Surgery is considered when symptoms persist despite a full non-operative programme.
OutcomesAround 80–90% of patients report good or excellent symptom relief after neurectomy in published series, as long as a neuroma is the primary problem and not secondary to other forefoot issues.
SpecialistMr Matthew Welck — Consultant Orthopaedic Foot and Ankle Surgeon at RNOH Stanmore and UCL. Private clinics in Central London, North London, and Hertfordshire. Sub-specialty interests: Morton’s neuroma, forefoot nerve pain, sports injuries of the foot and ankle, and total ankle replacement. matthewwelck.com

01

What Is Morton’s Neuroma?

Morton’s neuroma is a painful condition affecting one of the small nerves in the front of your foot. Despite the name, it is not actually a tumour. It is a thickening of the tissue around an interdigital nerve — usually the nerve that runs between the third and fourth toes — caused by long-standing irritation and compression as the nerve passes between the metatarsal heads.

Each step you take loads the forefoot with several times your body weight. When the nerve is repeatedly squeezed against the tight band of tissue between the metatarsals (the deep transverse intermetatarsal ligament), it responds by laying down scar tissue and swelling. This is sometimes called perineural fibrosis. Over time the affected nerve becomes hypersensitive and starts to fire abnormal signals — producing the burning, tingling, electric-shock pain that is so characteristic of the condition.

The 2 to 3, and 3 to 4 interspaces between the toes are by far the most commonly affected. The condition can occur in one foot or both, and occasionally more than one neuroma can develop in the same foot. Specialist assessment by a Consultant Foot & Ankle Surgeon — such as Mr Matthew Welck in London — gives you access to high-resolution imaging, image-guided injections, and the full range of surgical options if needed.

02

How Common Is It in the UK?

Morton’s neuroma is one of the most common causes of forefoot pain seen in specialist foot and ankle clinics in London and across the UK. Population studies suggest that symptomatic neuromas affect roughly 3–5% of adults, although asymptomatic thickening of the interdigital nerve can be picked up incidentally on ultrasound in a much higher proportion of people. It is also important to realise that a large number of neuromas are secondary to other problems in the forefoot, rather than a primary issue in an otherwise normal forefoot.

There is a strong gender bias: women are affected up to eight to ten times more often than men. The peak age of presentation is between 40 and 60, but the condition is also seen in younger, active patients — particularly runners, dancers, racquet-sport players, and those whose work or training involves long periods of weight-bearing on the forefoot.

03

What Causes Morton’s Neuroma?

Morton’s neuroma develops when an interdigital plantar nerve is repeatedly compressed and irritated. Several factors usually combine to produce the problem rather than a single cause.

Footwear

Tight, narrow, or pointed shoes squeeze the metatarsal heads together and push the nerve against the intermetatarsal ligament. High heels are a particular issue because they shift body weight forward onto the ball of the foot, increasing pressure across the very area where the nerve sits.

Foot Shape and Biomechanics

Patients with bunions (hallux valgus), flat feet, high arches, hammertoes, or a long second metatarsal often have abnormal load distribution across the forefoot. This focuses pressure on the third interspace and predisposes to nerve irritation. A tight calf or Achilles complex (gastrocnemius tightness) similarly drives load forward into the forefoot.

Sports and High-Impact Activity

Running, racquet sports, football, dance, and aerobics all involve repetitive forefoot loading. Sports injuries to the forefoot — such as plantar plate strains or metatarsal stress reactions — can alter local mechanics and provoke a neuroma. London-based runners and recreational athletes who train through forefoot pain are a common patient group in specialist foot and ankle clinics.

Previous Trauma or Surgery

A previous fracture, sprain, or surgical procedure on the forefoot can leave scar tissue or altered alignment that predisposes to nerve compression.

04

What Are the Symptoms?

Morton’s neuroma typically produces a very recognisable pattern of symptoms in the ball of the foot, most commonly between the third and fourth toes. Patients often describe several of the following:

  • An intermittent sharp, burning, or electric-shock pain radiating into the toes
  • Tingling, pins and needles, or numbness in the affected toes
  • The sensation of walking on a pebble, fold of sock, or marble in the shoe
  • Pain that is worse in tight or narrow shoes, and eased by removing the shoe and rubbing the foot. Pain that is worse barefoot is less likely to be a Morton’s neuroma.
  • Pain that flares with running, walking long distances, or standing for prolonged periods
  • A clicking or snapping sensation in the forefoot when the metatarsals are squeezed together (Mulder’s click)

Symptoms are usually intermittent at first and provoked by certain shoes or activities. Over time they tend to become more frequent and more disabling, particularly during sport and at the end of the working day. Significant rest pain or night pain is uncommon and should prompt assessment for other causes of forefoot pain.

05

Investigations

Morton’s neuroma is largely a clinical diagnosis. A specialist foot and ankle assessment — a careful history, examination, and targeted imaging — is the most important step.

Clinical Examination

The diagnosis can usually be made in the clinic. Tenderness in the affected interspace, reproduction of the patient’s pain when squeezing the forefoot, and a palpable Mulder’s click are highly suggestive. Sensation, alignment, and the state of neighbouring joints are all assessed at the same time, because conditions such as plantar plate tears, metatarsalgia, MTPJ synovitis, and stress fractures can mimic or coexist with a neuroma.

Ultrasound

High-resolution ultrasound is an excellent first-line imaging test. It allows the size and position of the neuroma to be measured directly, and crucially it can be combined with image-guided injection in the same visit. Most specialist London centres, including those used in Mr Welck’s private practice and similar units, offer this in a single appointment.

MRI

MRI is reserved for cases where the clinical picture is unclear, when ultrasound findings do not match the symptoms, or when other pathology — such as a stress fracture, plantar plate tear, or soft-tissue mass — needs to be excluded. MRI also has a role when planning revision surgery for recurrent neuromas.

Diagnostic Injection

In selected cases, a small injection of local anaesthetic into the suspected interspace can be used to confirm that the pain is genuinely arising from that nerve. Temporary symptom relief after the injection is reassuring before considering more invasive treatment.

06

Non-Surgical Treatment

The great majority of patients with Morton’s neuroma can be managed without surgery, particularly when the diagnosis is made early. A structured, stepwise programme is the standard of care, and it is important to give each step a fair trial before moving to the next.

Footwear Advice

Switching to shoes with a wide, deep toe box, a low heel, and a stiff sole reduces compression of the forefoot and is often the single most effective intervention. Patients are advised to avoid high heels and narrow, pointed shoes for prolonged periods.

Metatarsal Pads and Orthoses

A custom made insole with a metatarsal dome or pad placed just behind the ball of the foot lifts and spreads the metatarsal heads, taking pressure off the inflamed nerve. Custom orthoses can also address underlying biomechanical issues such as flatfoot or forefoot overload. Mr Welck works very closely with excellent orthotists.

Physiotherapy

Targeted physiotherapy is particularly valuable in active and sporting patients. Calf stretching, intrinsic foot strengthening, and gait retraining all help to redistribute load away from the symptomatic interspace.

Anti-Inflammatory Medication

A short course of oral or topical non-steroidal anti-inflammatory drugs (NSAIDs) can be helpful during a flare-up, provided there are no contraindications.

Ultrasound-Guided Steroid Injection

If footwear changes and orthoses do not settle the symptoms, an ultrasound-guided injection of corticosteroid and local anaesthetic into the affected interspace is the next step. Published series report that around 50–70% of patients gain meaningful relief from a well-placed injection, and the response is often long-lasting in smaller neuromas. There is a small risk of losing pigment colour where the injection goes in, and of wasting of some of the fat in the area.

Alcohol Sclerosing and Radiofrequency Ablation

In selected patients, ultrasound-guided alcohol injections or radiofrequency ablation can be used to chemically or thermally treat the nerve. These are minimally invasive alternatives to surgery and are typically reserved for patients who have not responded to steroid injection but wish to avoid open surgery. This is not something Mr Welck offers due to mixed published results and experience with these techniques.

07

Surgical Options

Surgery is considered when symptoms continue to limit daily life, work, or sport despite a full course of non-operative treatment — typically including footwear modification, orthoses, and one or two image-guided injections. The aim of surgery is reliable, long-term pain relief and a return to normal activity.

Neurectomy (Excision of the Neuroma)

Neurectomy is the most established surgical procedure for Morton’s neuroma. The thickened portion of the interdigital nerve is identified and removed, eliminating the abnormal pain signals. The operation can be carried out through either a dorsal (top of the foot) or plantar (sole) incision, depending on the surgeon’s preference and the specific case. It is usually performed as a day-case procedure under regional or general anaesthesia. Back in normal shoes at 2 weeks and swelling reduced by 6 weeks.

Nerve Decompression

In some patients — particularly those with smaller neuromas or first-time presentations in younger, active patients — the deep transverse intermetatarsal ligament can be released to decompress the nerve without removing it. This preserves sensation between the toes but has a slightly higher rate of recurrent symptoms in published series than neurectomy.

Recovery After Surgery

Most patients walk in a stiff post-operative shoe or boot for two weeks. Driving usually returns at four to six weeks, and most patients are back in normal shoes by 4 to 6 weeks. Return to running and high-impact sport is generally between three and six months. Patients should expect a permanent area of numbness between the affected toes after neurectomy — this is an expected consequence of the surgery, not a complication, and is well tolerated by the great majority of patients.

Outcomes and Risks: Published outcome studies report good or excellent results in approximately 80–90% of patients after primary neurectomy. As with any forefoot surgery, recognised risks include infection, wound healing problems, scar tenderness, persistent or recurrent pain, and stump neuroma — a small painful thickening at the cut end of the nerve, which occasionally requires revision surgery. These risks are discussed in detail at consultation so that each patient can make a fully informed decision.

08

Why Choose Mr Welck?

Mr Matthew Welck is a Consultant Orthopaedic Foot and Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore — one of the leading specialist orthopaedic centres in the UK — and an Honorary Associate Clinical Professor at University College London (UCL). He completed advanced fellowship training in foot and ankle surgery, including a period in Baltimore, USA, and has authored more than 50 peer-reviewed publications on foot and ankle conditions.

His private practice is based in Central London and North London, with clinic locations convenient for patients across Greater London, Hertfordshire, Middlesex, and the wider South-East. Mr Welck treats the full spectrum of foot and ankle conditions, with particular sub-specialty interest in Morton’s neuroma and other forefoot nerve disorders, sports injuries of the foot and ankle, complex hindfoot reconstruction, and total ankle replacement.

What patients can expect

  • Specialist consultant-led assessment from first appointment to discharge — there is no rotating junior team.
  • High-resolution diagnostic imaging including weight-bearing X-ray, ultrasound, weight-bearing CT, and MRI as required.
  • Image-guided injections delivered accurately to the affected nerve, often at the same visit as the diagnostic scan.
  • A full range of surgical options including dorsal and plantar neurectomy and nerve decompression, with day-case surgery at leading London private hospitals.
  • Tailored rehabilitation with a network of trusted London foot-and-ankle physiotherapists for sports injury recovery.
  • Transparent communication with your GP, referring consultant, and (where relevant) your sports medicine team.

Mr Welck co-organises the annual Stanmore Foot & Ankle Course and is actively involved in training the next generation of foot and ankle surgeons in the UK.

09

Frequently Asked Questions

Is Morton’s neuroma the same as a foot tumour?

No. Despite the name, a Morton’s neuroma is not a cancer or a true tumour. It is a benign thickening of the tissue around an interdigital nerve in the ball of the foot, caused by long-standing mechanical irritation.

Will Morton’s neuroma go away on its own?

Mild, early symptoms can settle with simple footwear changes and metatarsal pads. Once a neuroma is well established and producing classic symptoms, however, it rarely resolves completely without targeted treatment such as injection or, in resistant cases, surgery.

How is Morton’s neuroma diagnosed?

Diagnosis is made through a combination of a focused clinical examination — looking for tenderness in the interspace, a positive Mulder’s click, and reproduction of the typical pain — together with high-resolution ultrasound and/or MRI to confirm the size and location of the neuroma.

Are steroid injections safe?

Ultrasound-guided steroid injections are a well-established treatment with a strong safety profile when performed by experienced clinicians. Repeated injections in the same site are limited because of the small risk of fat-pad atrophy, skin thinning, and joint changes — usually no more than two or three injections are recommended in a single interspace.

When is surgery for Morton’s neuroma recommended?

Surgery is generally recommended when symptoms continue to limit daily life or sporting activity despite a full programme of non-operative treatment, including footwear advice, orthoses, physiotherapy, and image-guided injection.

How long is recovery after Morton’s neuroma surgery?

Most patients walk in a post-operative shoe for two to four weeks, return to normal shoes by six to eight weeks, and return to high-impact sport between three and six months after surgery, depending on the procedure performed and individual progress.

Can I run again after Morton’s neuroma surgery?

Yes. The great majority of patients return to recreational running and other sports after successful treatment. A graded return-to-running programme, supported by a sports physiotherapist, helps to minimise the risk of recurrence.

Do you treat sports injuries of the foot and ankle as well as Morton’s neuroma?

Yes. Mr Welck is a foot and ankle surgeon with a sub-specialty interest in sports injuries of the foot and ankle. His practice covers the full range of sports-related foot and ankle conditions — including ankle ligament injuries, ankle instability, Achilles tendon problems, plantar plate injuries, metatarsal stress fractures, and forefoot nerve problems such as Morton’s neuroma. He treats recreational and competitive athletes from across London, North London, and Hertfordshire.

Where in London and Hertfordshire can I see Mr Welck?

Mr Welck consults at clinic locations across Central London, North London, and Hertfordshire, including the Royal National Orthopaedic Hospital (RNOH) Stanmore site for NHS care and selected leading private hospitals for private patients. Patients travel from across Greater London, North London, Hertfordshire, Middlesex, and the wider South-East. Full clinic and contact details are available on matthewwelck.com.

Does Mr Welck perform total ankle replacement surgery?

Yes. Total ankle replacement is one of Mr Welck’s core sub-specialty interests, alongside Morton’s neuroma, forefoot nerve disorders, sports injuries of the foot and ankle, and complex hindfoot reconstruction. Ankle replacement is considered for patients with end-stage ankle arthritis when non-operative treatment no longer provides adequate relief. Suitability is assessed at consultation with weight-bearing X-rays, weight-bearing CT, and a careful review of your activity goals.

How do I book a consultation?

Appointments can be booked directly via the contact form on matthewwelck.com or by calling the practice. Self-pay and most major private medical insurers — including Bupa, AXA, Aviva, Vitality, and Cigna — are accepted; please check current cover with your insurer at the time of booking.

10

Book a Consultation

If you are experiencing pain, burning, or numbness in the ball of your foot, expert assessment and a clear treatment plan can make a substantial difference to your symptoms and to your quality of life. Most patients with Morton’s neuroma can be successfully managed without surgery when the condition is identified early and treated by an experienced foot and ankle specialist.

Mr Matthew Welck offers private consultations at clinic locations across Central London, North London, and Hertfordshire, with rapid access to ultrasound, MRI, image-guided injections, and — when needed — day-case surgery at leading London private hospitals. As well as Morton’s neuroma, the practice covers sports injuries of the foot and ankle, total ankle replacement, and the full spectrum of forefoot, midfoot, and hindfoot conditions. Self-pay patients and patients covered by all major UK private medical insurers are welcome.

To arrange a consultation, please visit matthewwelck.com or contact the practice directly. Referrals from GPs, physiotherapists, podiatrists, and sports medicine clinicians are warmly welcomed and acknowledged promptly.

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