Morton’s Neuroma and Neuroma Excision

Overview

Morton’s neuroma is irritation and thickening of an interdigital nerve in the forefoot, most often between the third and fourth toes. It is not a cancer or a true tumour. Similar symptoms can arise from metatarsal overload, plantar-plate injury, arthritis or stress injury, so the diagnosis should be confirmed before injection or surgery. Excision relieves pressure by removing part of a sensory nerve and therefore creates an expected area of permanent numbness.

Symptoms

Burning, tingling or electric pain into adjacent toes.
A sensation of a pebble, fold in the sock or clicking beneath the forefoot.
Pain in narrow shoes, high heels, running or prolonged standing.
Relief after removing the shoe and massaging the foot.
Intermittent numbness in the involved toes.

Assessment

Examination assesses the space between the affected toes, the bones beneath the ball of the foot, toe stability, callus pattern, foot alignment and nerve sensitivity. A click may be reproduced when the forefoot is compressed, but no single examination sign confirms the diagnosis.

Weight-bearing X-rays help identify arthritis, deformity or stress injury. Ultrasound can show an interdigital lesion and guide an injection. MRI is reserved for uncertain or atypical cases. Imaging findings must match symptoms because asymptomatic interdigital thickening can occur.

Non-surgical treatment

Shoes with a wide toe box, lower heel and adequate forefoot cushioning.
A correctly positioned metatarsal pad or insole (orthosis) to reduce pressure between the bones beneath the ball of the foot.
Adjustment of running, court sport or prolonged standing loads while symptoms settle.
Pain-relieving or anti-inflammatory medicine when appropriate.
An image-guided corticosteroid (cortisone) and local anaesthetic injection may provide temporary and occasionally sustained relief. Repeat injections require caution because of possible skin thinning, discolouration, fat-pad loss and soft-tissue effects.

When may surgery be considered?

Surgery may be discussed when characteristic symptoms continue to cause major limitations despite appropriate footwear, pressure redistribution and selected injection treatment, and when other causes of forefoot pain have been considered.

Options include releasing the ligament between the metatarsal bones to create more space around the nerve, or removing the affected segment of sensory nerve. Each option has limitations, and evidence does not identify one operation as best for every person. The approach depends on symptoms, anatomy and the surgeon’s assessment.

What should be expected after excision?

Removing a segment of the nerve produces a permanent numb area between the adjacent toes. This is expected rather than a complication. The nerve end is positioned away from pressure where possible, but a painful stump neuroma can still develop.

A postoperative shoe may be used while the wound settles. Swelling and forefoot sensitivity can persist for weeks or months, especially with prolonged standing or tight footwear.

Risks and limitations

Infection, wound problems, bleeding or blood clots.
Permanent numbness in the affected space between the toes after nerve excision.
Persistent or recurrent pain, including stump neuroma.
Scar sensitivity, complex regional pain syndrome or nerve hypersensitivity.
Ongoing pain beneath the ball of the foot if another source of forefoot overload remains.
Need for further investigation or surgery.

When to seek prompt review

Rapidly worsening swelling, redness, fever, an ulcer, loss of circulation, constant severe night pain or progressive weakness/numbness requires review. Sudden forefoot pain after increased activity may represent stress injury rather than a neuroma.

Frequently asked questions

Is Morton’s neuroma a cancer?

No. It is a non-cancerous thickening and irritation of an interdigital nerve.

Do I need an MRI?

Usually not. Clinical assessment, weight-bearing X-rays and sometimes ultrasound are sufficient. MRI is useful when the diagnosis is uncertain.

Will an injection cure it?

An injection may reduce symptoms for a period and can support the diagnosis, but response varies and recurrence is possible.

Will my toes be numb after excision?

Yes. A small permanent numb area between the involved toes is expected because part of the sensory nerve is removed.

Can pain recur after surgery?

Yes. A stump neuroma, scar sensitivity or another source of forefoot pain can produce persistent or recurrent symptoms.

General information

This page provides general information only. It cannot diagnose your condition or replace advice from a clinician who has assessed you. Your treatment and recovery plan may differ from the examples described here. Follow the instructions from your treating team. In an emergency, call 000 or attend the nearest emergency department.