Burning Pain in the Ball of Your Foot: Is It Morton’s Neuroma?

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Expert Patient Guide · Foot & Ankle Surgeon · London & North London

Burning Pain in the Ball of Your Foot: Is It Morton’s Neuroma?

A clear, evidence-based guide to burning or electric pain in the ball of the foot — what a Morton’s neuroma actually is, why a scan alone cannot make the diagnosis, and which treatments genuinely help — written by Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH), Stanmore, and UCL.

At a Glance

Most people describe a burning or electric pain between the third and fourth toes. It is worse in narrow or high-heeled shoes, often comes with numbness in the toes either side, and eases when the shoe comes off and the foot is rubbed.

Not all pain in the ball of the foot is a Morton’s neuroma. A neuroma can also develop because the front of the foot is being overloaded, and that underlying problem needs treating too.

It isn’t really a neuroma. The nerve has thickened from long-term irritation and scarring rather than growing into a tumour, which is why the more accurate name is interdigital neuroma, or Morton’s metatarsalgia.

A scan showing a neuroma does not mean you have symptoms from one. Nerve thickening on ultrasound or MRI is common in people with no pain at all in the front of the foot — examining the foot, rather than scanning it, is the most reliable way to make the diagnosis.

The evidence on steroid injections is genuinely divided, and while surgery works well for the right patients, it leaves permanent numbness in the toes either side of the nerve that is removed.

01

What It Feels Like

Patients describe it in remarkably similar ways, which is why the diagnosis is mostly made by listening.
  • Burning, electric or shooting pain in the ball of the foot, spreading into two toes next to each other
  • A sensation of walking on a pebble, or of a sock bunched up under the foot
  • Numbness or tingling in the sides of the two toes either side of the affected space
  • Worse in narrow, pointed or high-heeled shoes, and worse the longer you are on your feet
  • Relieved by stopping, removing the shoe and massaging the forefoot — patients frequently describe doing this in public and being slightly embarrassed about it
  • Sometimes a click that you can feel when the ball of the foot is squeezed
It most often affects the space between the third and fourth toes, and next most often the space between the second and third. More than one space in the same foot is uncommon, and should prompt a rethink of the diagnosis.
02

What Is Actually Happening

The nerve that gives feeling to the toes runs between the heads of the long foot bones (the metatarsals), underneath a stiff band of tissue. In that tight space it can be squeezed and irritated again and again, particularly when shoes press the front of the foot narrow, or when a lot of weight goes through the ball of the foot. Over time the nerve thickens and scars. The word “neuroma” sounds like a growth, which is misleading — nothing is growing, and nothing is cancerous. Interdigital neuroma, or Morton’s metatarsalgia, describes it more accurately. Things that make it more likely include narrow or high-heeled shoes, a high-arched foot, a bunion or a bent lesser toe crowding the front of the foot, high-impact activity, and carrying more weight.
03

The Problem With Scans

This is the most important section on this page, and the one most likely to be different from what you have already been told. Two studies illustrate it well. On ultrasound: 48 volunteers with no pain at all in the front of the foot were scanned by specialist radiologists to look for thickening of the nerve between the toes. Fifty-four per cent had thickening greater than 5 mm, and 35% had it in both feet. It became more common with age. The authors concluded that ultrasound often picks up findings that mean nothing on their own, which can lead to a wrong diagnosis, and that examining the foot remains the most reliable test. On MRI: of 57 patients who had no signs of the condition when examined, 33% had scans that met the criteria for Morton’s neuroma. In people who did have symptoms the nerve was slightly larger on average — 5.3 mm compared with 4.1 mm — but the two groups overlapped a great deal. The authors concluded that an MRI diagnosis of Morton’s neuroma does not mean the nerve is causing symptoms.
Why it matters: A report saying “Morton’s neuroma” describes how wide the nerve is, not proof that it is the source of your pain. If the scan finding does not match where your symptoms actually are, it is probably an incidental finding — and operating on it will not help.
This matters because several other problems in the same part of the foot cause similar pain:
  • Overload of the ball of the foot (metatarsalgia)
  • A stress fracture in one of the long foot bones
  • A tear in the ligament at the base of a toe (the plantar plate)
  • Inflammation of the joint lining
  • Freiberg’s disease
Each one is treated differently.
04

How the Diagnosis Should Be Made

A careful clinical examination, not the scan report, is what should drive the diagnosis:
  • Exactly where the pain is — between the heads of the long foot bones, or under one of them? Neuroma pain sits between them; metatarsalgia sits under them
  • Tenderness when the space between the toes is squeezed from above and below
  • Mulder’s click — squeezing the front of the foot from side to side while pressing on the space, producing a click you can feel and often hear, along with a jolt of pain
  • Checking the feeling in the sides of the two toes either side
  • An assessment of the whole front of the foot — bunion, toe shape, the ligaments at the base of the toes, and the shape of your foot
  • Scans only where they will change something: standing X-rays to rule out other bone causes, and ultrasound or MRI where the picture is unclear or surgery is being planned — always read alongside the examination, never instead of it
  • Sometimes a local anaesthetic injection is the most direct test: if numbing that particular space takes the pain away, the diagnosis is confirmed
05

Treatment: Footwear and Offloading — Start Here

It is not exciting, and it is where most people get better.
  • Shoes with a wide toe area. Narrow, pointed shoes press on exactly the space involved. For a good number of people, this change on its own settles the symptoms
  • Lower heels. A high heel shifts your weight forward onto the ball of the foot
  • A metatarsal dome or pad, placed just behind the ball of the foot to spread the bones apart and take pressure off the space. Where it sits matters — too far forward and it makes things worse
  • A shoe with a stiffer sole, so the front of the foot bends less
  • Easing off activity while symptoms are flaring
06

Treatment: Steroid Injection

If changing your shoes is not enough, an injection is usually the next step. The evidence deserves setting out honestly, because two randomised trials reached different conclusions.

The Larger Trial — Edinburgh, 131 Patients

Compared an ultrasound-guided steroid injection (methylprednisolone) plus anaesthetic against anaesthetic on its own. The steroid group had clearly better overall foot health at three months — on average 14 points better on a 100-point score — with benefit at one month too. The size of the neuroma on ultrasound did not predict who would respond.

The Smaller Trial — 41 Patients

Found no meaningful difference between steroid plus anaesthetic and anaesthetic on its own at three or six months. Notably, 48.5% of all the patients in the study went on to ask for surgery to remove the nerve, with no difference between the groups.
A review pooling 12 studies and 1,438 patients found steroid injections effective, with alcohol (a sclerosant), hyaluronic acid and capsaicin injections also helping, and no serious side effects reported.
A fair summary: a steroid injection is a reasonable step that helps a good proportion of people for a period of months. It is not a dependable cure, the trial evidence is inconsistent, and repeated injections into the front of the foot risk thinning the natural padding and lightening the skin. One or two, guided by ultrasound, is a sensible limit.
07

Surgical Options and Recovery

If symptoms carry on despite changing your shoes and having an injection, surgery is effective. A review of 29 studies found better results from surgery than from non-surgical care or injections, while noting that better trials are still needed.

Neurectomy

Removing the affected nerve is the traditional operation, usually done through a small cut on the top of the foot. It reliably relieves the pain in most people. The unavoidable trade-off is permanent numbness in the sides of the two toes either side, which most patients cope with easily but must know about beforehand. The main complication is a stump neuroma: a painful scar at the cut end of the nerve, which affects a minority of people and is harder to treat than the original problem.

Neurolysis

Releasing the tight band of tissue to take the pressure off the nerve, rather than removing it, keeps the feeling in the toes. A review of alternatives to neurectomy found that nerve-related symptoms after the operation were less common after neurolysis than after neurectomy, and recommended that where the nerve is moved to a new position, this is combined with releasing it rather than done on its own. It was more cautious about keyhole decompression and shortening one of the long foot bones, where it is still unclear how well they work.
The same review made one practical recommendation strongly: if the nerve is cut, the cut end should be tucked into muscle or moved to a new position, to reduce the risk of a painful stump.

Recovery after surgery

MilestoneTypical timing
Weight-bearingImmediately, in a post-operative shoe
Stitches outAround 2 weeks
Into a wide trainer3–6 weeks
Desk work1–2 weeks
Standing or manual work6–8 weeks
Swelling settled3–6 months
Final result6–12 months
The numbness after a neurectomy is permanent and does not wear off. A sensitive scar on the top of the foot is common for several months.
08

Why Choose Mr Welck?

Pain in the ball of the foot has several causes that feel much the same but are treated differently, and a Morton’s neuroma is both commonly diagnosed and commonly over-diagnosed on scans. The most useful thing a specialist assessment gives you is confidence that what is being treated really is what is causing the pain. Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH), Stanmore, and Honorary Associate Clinical Professor at UCL. He assesses and treats problems in the front of the foot, including Morton’s neuroma, metatarsalgia and lesser toe problems, with clinics across North and Central London. Patients choosing Mr Welck benefit from:
  • An examination-led diagnosis, with scans used to confirm rather than replace clinical assessment
  • Access to ultrasound-guided injections and the full range of surgical options, including neurolysis
  • Subspecialist fellowship training in foot and ankle surgery
  • Treatment of NHS and private patients across London and North London, including RNOH Stanmore
09

Frequently Asked Questions

What does Morton’s neuroma feel like?

Burning, electric or shooting pain in the ball of the foot spreading into two adjacent toes, often with numbness, classically described as walking on a pebble. It is worse in narrow or high-heeled shoes and relieved by removing the shoe and rubbing the foot.

Is a Morton’s neuroma a tumour?

No. Nothing is growing and nothing is cancerous. The nerve has thickened and scarred from long-term irritation, which is why “interdigital neuroma” is a more accurate description.

My scan showed a neuroma — does that mean it is causing my pain?

Not necessarily. In an ultrasound study of people with no pain in the front of the foot at all, 54% had nerve thickening over 5 mm, and an MRI study found neuromas in 33% of patients who had no signs of the condition when examined. The scan finding has to match what is found on examination to mean anything.

Will changing my shoes really help?

For many people, yes, and it is the first thing to try. Shoes with a wide toe area, a lower heel, a stiffer sole and a correctly placed metatarsal dome tackle the cause directly.

Do steroid injections work for Morton’s neuroma?

The evidence is mixed. A randomised trial of 131 patients found a significant benefit at three months; a smaller trial found no advantage over local anaesthetic on its own, and nearly half of those patients went on to ask for surgery. It is a reasonable step that helps many people for a period, rather than a dependable cure.

How many injections can I have?

Generally one or two, guided by ultrasound. Repeated injections into the front of the foot risk thinning the natural padding and lightening the skin.

Will I be left with numb toes after surgery?

After a neurectomy, yes — the numbness in the sides of the two toes either side is permanent. Most people find it a minor trade-off for pain relief, but it should be understood before you agree to the operation. Neurolysis keeps the feeling in the toes and is linked with fewer nerve symptoms afterwards.

What is a stump neuroma?

A painful scar that forms at the cut end of the nerve after it is removed. It affects a minority of patients and is harder to treat than the original problem, which is why the cut end is usually tucked into muscle or moved to a new position.

Can it come back after surgery?

The nerve that was removed does not grow back, but symptoms can return — most often from a stump neuroma, or from a different problem in the same area that was the real cause all along.
10

Book a Consultation

Pain in the ball of the foot has several possible causes, and a Morton’s neuroma is both commonly diagnosed and commonly over-diagnosed on scans. If you have burning or electric pain, numbness in the toes, or a scan report that has not resolved things, an expert review is the most reliable way to get the right diagnosis and the right plan. To arrange a consultation with Mr Matthew Welck:

This page is provided for general information and patient education only. It does not replace personalised medical advice. Always consult a qualified specialist for diagnosis and treatment.

References

  1. Symeonidis PD, Iselin LD, Simmons N, Fowler S, Dracopoulos G, Stavrou P. Prevalence of interdigital nerve enlargements in an asymptomatic population. Foot Ankle Int. 2012;33(7):543–547. doi:10.3113/FAI.2012.0543
  2. Bencardino J, Rosenberg ZS, Beltran J, Liu X, Marty-Delfaut E. Morton’s neuroma: is it always symptomatic? AJR Am J Roentgenol. 2000;175(3):649–653. doi:10.2214/ajr.175.3.1750649
  3. Thomson CE, Beggs I, Martin DJ, et al. Methylprednisolone injections for the treatment of Morton neuroma: a patient-blinded randomized trial. J Bone Joint Surg Am. 2013;95(9):790–798. doi:10.2106/JBJS.I.01780
  4. Lizano-Díez X, Ginés-Cespedosa A, Alentorn-Geli E, et al. Corticosteroid Injection for the Treatment of Morton’s Neuroma: A Prospective, Double-Blinded, Randomized, Placebo-Controlled Trial. Foot Ankle Int. 2017;38(9):944–951. doi:10.1177/1071100717709569
  5. Valisena S, Petri GJ, Ferrero A. Treatment of Morton’s neuroma: A systematic review. Foot Ankle Surg. 2018;24(4):271–281. doi:10.1016/j.fas.2017.03.010
  6. Choi JY, Hong WH, Kim MJ, Chae SW, Suh JS. Operative treatment options for Morton’s neuroma other than neurectomy — a systematic review. Foot Ankle Surg. 2022;28(4):450–459. doi:10.1016/j.fas.2021.10.011
  7. Millán-Silva MO, Munuera-Martínez PV, Távara-Vidalón P. Infiltrative Treatment of Morton’s Neuroma: A Systematic Review. Pain Manag Nurs. 2024;25(6):628–637. doi:10.1016/j.pmn.2024.06.005

Study data above retrieved via PubMed.

Written by: Matthew Welck | Consultant Orthopaedic Foot & Ankle Surgeon London — last updated 2 September 2026

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