Morton's Neuroma

Several conditions sit in almost exactly the same spot. The clinical list of things that can be mistaken for a Morton's neuroma includes ⁶:

• Intermetatarsal bursitis: an irritated fluid-filled sac between the long bones of the forefoot.
• A stress fracture in one of those bones: a bone problem, not a nerve one.
• Freiberg's infraction: damage to the rounded head at the end of one of those bones.
• An unstable or inflamed toe joint at the ball of the foot.
• Arthritis in the joints of the forefoot.
• Less commonly, a soft-tissue lump such as a lipoma or a ganglion.

What points towards the nerve is the character of the pain: shooting, stabbing or burning between two toes, sometimes tingling or numbness, and that pebble feeling ¹. If yours is more of a general ache across the ball of the foot, our Metatarsalgia page is the better place to start.

Sorting them out is hands-on: squeezing the forefoot across its width, feeling for a painful click between the metatarsal heads, and stretching the nerve to see whether that reproduces your symptoms ³.

And the scan question. A thickened nerve on an ultrasound is not a diagnosis on its own. When researchers scanned 96 feet belonging to volunteers with no forefoot symptoms at all, 54% showed a thickened nerve between the toes ⁴. Their conclusion: clinical examination is still the gold standard ⁴. If imaging is needed, ultrasound is about as sensitive as MRI and likely the more cost-effective choice ⁵. It supports the examination. It doesn't replace it.

This is diagnosed with hands, not a scanner. Your clinician examines the foot ¹, and that examination is still regarded as the gold standard ⁴. One thing we feel for is Mulder's click. The forefoot is squeezed across its width while the gap between the bones is pressed, and a neuroma can give a painful click you can feel ⁶. In one study, feet with that click were more likely to show a thickened nerve on ultrasound ⁴.

A scan is for when the examination leaves doubt. An ultrasound finding is unreliable unless it's matched against the examination ⁴. Ultrasound and MRI are about equally sensitive, each picking up roughly 90 per cent of neuromas later confirmed at surgery ⁵. If you need more than first-line care, a GP can refer you to a foot specialist ¹.

A Morton's neuroma is a squeezed nerve, not an injury that heals on a schedule, so The Well Motion Recovery Path™ is about calming the nerve, then building up what your foot can take. You move up a phase on what the foot tolerates, not on a date.

• Reset: the first weeks. Roomier shoes, a metatarsal pad or soft insole and less impact ¹, alongside hands-on treatment. Expect good and bad days that follow your footwear. We move you on once an ordinary day in sensible shoes no longer sets it off.
• Rebuild: foot and toe strengthening, with time on your feet added back in steps. Expect the odd flare when the load goes up. That tells us to hold, not to stop. We move you on when the foot does what your daily tasks ask of it.
• Return: a full shift in work boots for some people, running or court sport for others. We test that task in the footwear you will wear for it. You leave with a footwear plan.

How long it usually takes. It varies, and no treatment is an established gold standard ². In one study, shoe changes and padding eased symptoms in about a third of cases, after 4.5 months on average ⁶. Orthopaedic patient guidance, not trial data, says surgery may be recommended if symptoms have not improved within 3 to 6 months ⁹. That decision sits with your GP or a specialist ¹.

No trial has tested how to prevent Morton's neuroma or its flare-ups. Each of these goes after a recognised cause instead:

• The toe box. Tight, pointy shoes are a listed cause ¹. A review of footwear for this condition says shoes should be long enough and broad across the toes ⁶.
• Heel height and sole. High heels add to the compression on the nerve ⁶. The same review recommends a flat heel and an outer sole that's thick enough and not too bendy ⁶. Thin soles are on the list to avoid ¹.
• Running and jumping. Sports that put pressure on the feet are another cause ¹. Cut back on impact while the foot is irritable ¹.
• Time. One study in that review found shoe changes and padding eased symptoms in about a third of cases, after 4.5 months on average. Past that point, or once the neuroma is larger than 5 to 6 mm, they don't seem to do much ⁶. If two weeks of looking after it yourself hasn't helped, get it checked ¹.