Morton's Neuroma: Causes, Symptoms and Treatment

That feeling of a pebble stuck permanently in your shoe, right between your toes, usually isn't a pebble at all, it's a thickened, irritated nerve.
Not Actually a Tumour
Despite the name, Morton's neuroma isn't a true tumour, it's a form of nerve irritation in the foot.'t a true tumour, it's a thickening of the tissue surrounding one of the small nerves running between the toes, most commonly between the third and fourth toes. Over time, repetitive compression of this nerve as it passes between the toe bones causes the surrounding tissue to thicken, which in turn increases irritation of the nerve itself, creating something of a self-perpetuating cycle.
How It Presents
The classic description is a sharp, burning pain in the ball of the foot, often accompanied by a sensation of walking on a pebble, a fold in your sock, or a small lump inside the shoe that isn't actually there. Numbness or tingling in the affected toes is common, and symptoms are typically worse in tight, narrow, or high-heeled footwear and better when barefoot or in wide, supportive shoes.
Why Footwear Plays Such a Large Role
Narrow toe boxes and high heels both increase pressure. Book an assessment, imaging is rarely needed for diagnosis. across the ball of the foot and compress the toes together, which directly irritates the nerve. This is a large part of why Morton's neuroma is significantly more common in people who regularly wear this kind of footwear, and why footwear modification is such a central part of treatment.
Getting the Diagnosis Right
A focused clinical examination, including palpation between the toe bones, is usually enough to identify Morton's neuroma. Tarsal tunnel syndrome affects the sole of the foot and is a useful differential to know. and specific compression tests that reproduce the symptoms, is usually enough to identify Morton's neuroma clinically. Imaging such as ultrasound can help confirm the diagnosis and assess the size of the thickened tissue where the clinical picture is less clear or where treatment isn't progressing as expected.
What Treatment Typically Involves
Switching to wider, well-cushioned footwear with a lower heel is usually the first and most impactful step. Beyond that, treatment can include padding or orthotic support to offload the area, soft tissue and nerve mobilisation work, and activity modification while the irritated tissue settles. Where conservative measures haven't produced meaningful improvement after a reasonable trial, further options can be discussed with your treating team.
Related Reading
← Back to the full Nerve Pain guideFor educational purposes only. Does not supersede advice from your GP or specialist.
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