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Morton’s Neuroma Treatment at Foot Foundation

Burning, shooting pain or “pebble in the shoe” sensation often signals a neuroma—nerve thickening between the metatarsals.

Foot Foundation provides precise diagnosis, neuroma-specific orthotics and met pads, footwear optimisation, and graded load plans. We also coordinate ultrasound-guided injections or surgical referral when required.

What is Morton’s Neuroma?

Morton’s neuroma is a painful thickening (perineural fibrosis) of a plantar digital nerve, most commonly in the third intermetatarsal space (between the 3rd and 4th toes) and less often the second space. It is not a true tumour. Repetitive compression and shear lead to nerve irritation, oedema, and fibrotic enlargement, causing burning or electric pain in the forefoot and toes.

Patients typically report sharp, burning, or shooting pain, sometimes with numbness in adjacent toes and a sensation of “walking on a pebble.” Pain is often provoked by tight or narrow shoes and relieved by removing footwear or massaging the forefoot.

At Foot Foundation, we perform a comprehensive biomechanical assessment and deliver an evidence-based plan to offload the nerve, optimise footwear, and restore function. Where appropriate, we coordinate ultrasound-guided interventions or surgical referral.

Causes & Risk Factors

  • Footwear: narrow toe boxes, high heels, thin or hard soles increasing forefoot compression

  • Biomechanics: forefoot overload, tight calf (limited ankle dorsiflexion), hypermobility, hallux valgus, cavus foot (hindfoot varus, plantarflexed first ray)

  • Activity load: running, court sports, hiking—especially on hard surfaces

  • Occupational standing or long walking on firm floors

  • Adjacent pathology: metatarsalgia, MTP joint synovitis/instability, hammertoes

  • Female sex and age 30–60 commonly affected

  • Previous forefoot trauma or surgery

Treatment at Foot Foundation

Conservative care is first-line and effective for many patients:

  • Custom orthotics (neuroma-specific):

    • Metatarsal dome/pad to splay the metatarsals and decompress the webspace

    • Posting and cushioning tailored to foot type (cavus vs planus) to reduce focal forefoot load

  • Footwear prescription:

    • Wide toe box, adequate depth, cushioned midsole, mild rocker to reduce forefoot pressure

    • Avoid narrow, pointed, or high-heeled shoes; consider lacing patterns to reduce forefoot compression

  • Load modification & activity strategy: graded return, surface modification, cadence tweaks for runners

  • Calf flexibility & mobility: reduce forefoot overload from limited ankle dorsiflexion

  • Intrinsic & peroneal strengthening: improve forefoot stability and pressure distribution

  • Manual therapy / mobilisation: optimise MTP and midfoot mechanics

  • Strapping/padding for short-term symptom relief

When symptoms persist despite optimal conservative care, we coordinate medical interventions:

  • Ultrasound-guided corticosteroid injection for pain and inflammation reduction

  • Alcohol (sclerosing) injections in selected recurrent cases (via specialist)

  • Radiofrequency ablation or cryoablation (specialist centres)

  • Surgical referral (neurectomy or decompression) for resistant cases after thorough conservative trial

We’ll help you navigate options, expected outcomes, and recovery timelines, ensuring continuity of care pre- and post-procedure.

Symptoms

  • Burning, shooting, or stabbing pain in the ball of the foot, often radiating into adjacent toes

  • Tingling or numbness in the sides of two neighbouring toes

  • “Pebble in the shoe” or “sock bunched up” sensation

  • Pain worsens with tight shoes, forefoot loading, or prolonged standing; improves with shoe removal and rest

  • Possible click on squeezing the forefoot (Mulder’s click)

Diagnosis

Diagnosis is primarily clinical, supported by targeted tests and imaging where needed:

  • History & provocation: pain pattern, footwear triggers, relief with shoe removal

  • Physical exam: forefoot squeeze tests, palpation of webspaces, assessment for Mulder’s click

  • Biomechanical & gait analysis: calf length, arch profile, forefoot loading pattern

  • Imaging (when needed):

    • Ultrasound to visualise a neuroma and guide injections

    • MRI in complex or atypical cases, or to differentiate from intermetatarsal bursitis, stress fracture, or MTP synovitis

Diagnostic injection: local anaesthetic relief supports diagnosis

Differentials: intermetatarsal bursitis, MTP synovitis/instability, stress fracture, Freiberg disease, tarsal tunnel–related pain, capsulitis, sesamoid pathology.

Morton’s Neuroma – FAQs

Why Choose Foot Foundation?

Foot Foundation provides specialist-level forefoot assessment with targeted offloading, orthotic design, footwear optimisation, and progressive rehabilitation. We coordinate ultrasound-guided injections and surgical referral where indicated, and support return to work and sport with graded loading plans.

With clinics in Rosedale, Takapuna, Remuera, Botany, Hamilton, and Tauranga, expert forefoot care is available across New Zealand.

Explore our
General Foot Pain pages

Metatarsalgia

Sesamoiditis

Hallux Limitus / Rigidus

 

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