Morton's Neuroma
What is Morton's neuroma?
Morton's neuroma is a painful thickening of the tissue surrounding one of the digital nerves in the forefoot — most commonly the nerve running between the third and fourth metatarsal heads, though the second and third interspace is also affected. Despite its name, it is not a true neuroma (a tumour of nerve tissue) but rather a perineural fibrosis — a scarring and thickening of the sheath surrounding the nerve in response to chronic compression and irritation.
The nerve becomes entrapped between adjacent metatarsal heads and the transverse intermetatarsal ligament that runs across the ball of the foot, and repeated compression with each step produces the characteristic symptoms. Women are affected approximately four to five times more frequently than men, largely due to footwear choices that compress the forefoot and drive the toes together.
What are the symptoms?
Morton's neuroma has a fairly distinctive symptom pattern that separates it from other causes of forefoot pain. The most characteristic description is a burning, sharp or electric pain in the ball of the foot between the toes — often described as feeling like standing on a pebble or a fold in a sock that isn't there. Tingling or numbness extending into the adjacent toes (most commonly the third and fourth) is common. Many patients describe a clicking sensation when weight is applied to the forefoot.
Symptoms are typically provoked by standing, walking and particularly by wearing narrow or high-heeled shoes that compress the forefoot. Relief on removing shoes and massaging the forefoot is characteristic and diagnostically useful. The pain often improves with rest and when walking barefoot on soft surfaces.
What causes Morton's neuroma?
The underlying mechanism is chronic compression and traction on the interdigital nerve. The condition is often associated with repetitive stress, wearing tight or ill-fitting footwear, foot deformities, or trauma. High heels transfer excessive load to the forefoot and compress the metatarsal heads together, while narrow toe boxes squeeze the forefoot laterally and reduce the space available for the interdigital nerve. Biomechanical factors — flat feet, bunions, high arches, and hammer or claw toes — alter forefoot load distribution in ways that increase nerve compression risk. Repetitive impact activities including running and court sports are associated with higher incidence in athletes.
How is it diagnosed?
Mulder's click — compressing the forefoot laterally while simultaneously applying dorsoplantar pressure to the affected interspace — reproduces a palpable and sometimes audible click with pain in the affected area, and is the most characteristic clinical test. Localised tenderness in the affected web space on direct palpation, and reproduction of symptoms with the web space compression test, supports the diagnosis.
Ultrasound is the most accessible and cost-effective imaging for Morton's neuroma — it directly visualises the hypoechoic perineural mass and can guide diagnostic or therapeutic injections. MRI provides additional information about surrounding structures and is useful when the diagnosis is uncertain or other forefoot pathology needs to be excluded.
How can physiotherapy help?
Conservative management is effective for many cases of Morton's neuroma, particularly when the neuroma is smaller and symptoms are of shorter duration. Footwear advice is one of the most impactful interventions — recommendations on appropriate footwear to reduce pressure on the affected area combined with metatarsal padding to offload the nerve, and activity modification to reduce aggravating loads, form the foundation of conservative management.
Metatarsal domes or pads placed just proximal to the affected interspace spread the metatarsal heads apart, reducing the compressive forces on the entrapped nerve during walking. Your physiotherapist will advise on appropriate padding placement and orthotic options — a custom foot orthosis with a metatarsal raise can be very effective for patients in whom off-the-shelf padding has not been sufficient.
Manual therapy techniques including joint mobilisation of the intermetatarsal and metatarsophalangeal joints improve forefoot mobility and reduce the local tissue stiffness that contributes to nerve compression. Intrinsic foot muscle strengthening — particularly the lumbricals and interossei that stabilise the metatarsal heads — helps restore normal forefoot mechanics. Neural mobilisation techniques for the plantar digital nerves can reduce the mechanosensitivity that makes the nerve hypersensitive to compression.
For patients whose Morton's neuroma is associated with biomechanical contributors — flat feet, Achilles tightness, or plantar fasciitis — addressing these as part of the overall foot rehabilitation program improves and sustains outcomes.
For patients not responding adequately to conservative management, referral for ultrasound-guided corticosteroid injection is appropriate — research suggests this is effective in the majority of cases. Surgical excision of the neuroma or nerve decompression is reserved for cases where conservative and injection management has failed.
Our physiotherapists Yulia Khasyanova and Emma Cameron both have experience in foot and ankle conditions and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Morton's neuroma is a painful thickening of the tissue surrounding one of the digital nerves in the forefoot — most commonly the nerve running between the third and fourth metatarsal heads, though the second and third interspace is also affected. Despite its name, it is not a true neuroma (a tumour of nerve tissue) but rather a perineural fibrosis — a scarring and thickening of the sheath surrounding the nerve in response to chronic compression and irritation.
The nerve becomes entrapped between adjacent metatarsal heads and the transverse intermetatarsal ligament that runs across the ball of the foot, and repeated compression with each step produces the characteristic symptoms. Women are affected approximately four to five times more frequently than men, largely due to footwear choices that compress the forefoot and drive the toes together.
What are the symptoms?
Morton's neuroma has a fairly distinctive symptom pattern that separates it from other causes of forefoot pain. The most characteristic description is a burning, sharp or electric pain in the ball of the foot between the toes — often described as feeling like standing on a pebble or a fold in a sock that isn't there. Tingling or numbness extending into the adjacent toes (most commonly the third and fourth) is common. Many patients describe a clicking sensation when weight is applied to the forefoot.
Symptoms are typically provoked by standing, walking and particularly by wearing narrow or high-heeled shoes that compress the forefoot. Relief on removing shoes and massaging the forefoot is characteristic and diagnostically useful. The pain often improves with rest and when walking barefoot on soft surfaces.
What causes Morton's neuroma?
The underlying mechanism is chronic compression and traction on the interdigital nerve. The condition is often associated with repetitive stress, wearing tight or ill-fitting footwear, foot deformities, or trauma. High heels transfer excessive load to the forefoot and compress the metatarsal heads together, while narrow toe boxes squeeze the forefoot laterally and reduce the space available for the interdigital nerve. Biomechanical factors — flat feet, bunions, high arches, and hammer or claw toes — alter forefoot load distribution in ways that increase nerve compression risk. Repetitive impact activities including running and court sports are associated with higher incidence in athletes.
How is it diagnosed?
Mulder's click — compressing the forefoot laterally while simultaneously applying dorsoplantar pressure to the affected interspace — reproduces a palpable and sometimes audible click with pain in the affected area, and is the most characteristic clinical test. Localised tenderness in the affected web space on direct palpation, and reproduction of symptoms with the web space compression test, supports the diagnosis.
Ultrasound is the most accessible and cost-effective imaging for Morton's neuroma — it directly visualises the hypoechoic perineural mass and can guide diagnostic or therapeutic injections. MRI provides additional information about surrounding structures and is useful when the diagnosis is uncertain or other forefoot pathology needs to be excluded.
How can physiotherapy help?
Conservative management is effective for many cases of Morton's neuroma, particularly when the neuroma is smaller and symptoms are of shorter duration. Footwear advice is one of the most impactful interventions — recommendations on appropriate footwear to reduce pressure on the affected area combined with metatarsal padding to offload the nerve, and activity modification to reduce aggravating loads, form the foundation of conservative management.
Metatarsal domes or pads placed just proximal to the affected interspace spread the metatarsal heads apart, reducing the compressive forces on the entrapped nerve during walking. Your physiotherapist will advise on appropriate padding placement and orthotic options — a custom foot orthosis with a metatarsal raise can be very effective for patients in whom off-the-shelf padding has not been sufficient.
Manual therapy techniques including joint mobilisation of the intermetatarsal and metatarsophalangeal joints improve forefoot mobility and reduce the local tissue stiffness that contributes to nerve compression. Intrinsic foot muscle strengthening — particularly the lumbricals and interossei that stabilise the metatarsal heads — helps restore normal forefoot mechanics. Neural mobilisation techniques for the plantar digital nerves can reduce the mechanosensitivity that makes the nerve hypersensitive to compression.
For patients whose Morton's neuroma is associated with biomechanical contributors — flat feet, Achilles tightness, or plantar fasciitis — addressing these as part of the overall foot rehabilitation program improves and sustains outcomes.
For patients not responding adequately to conservative management, referral for ultrasound-guided corticosteroid injection is appropriate — research suggests this is effective in the majority of cases. Surgical excision of the neuroma or nerve decompression is reserved for cases where conservative and injection management has failed.
Our physiotherapists Yulia Khasyanova and Emma Cameron both have experience in foot and ankle conditions and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
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