A Morton’s neuroma is a thickened bundle of interdigital nerve tissue—usually between the 3rd and 4th metatarsal heads—that sparks stabbing forefoot pain, tingling, or the infamous “pebble in my shoe” sensation. Our board-certified podiatrists combine ultrasound-guided diagnosis with tiered, evidence-based care—from metatarsal-pad orthotics to percutaneous decompression—so you can stand, walk, and run without forefoot fire.
| Mechanical Over-load | Anatomical Contributors | Systemic / Footwear |
|---|---|---|
| Repetitive compression of the interdigital nerve between metatarsal heads | Narrow intermetatarsal angle (women > men) | High-heels or tight, pointed shoes |
| Hyper-pronation causing metatarsal shear | Hypermobility of 1st ray leading to lateral shift of load | Running on hard surfaces, sprint starts |
| Metatarsal length discrepancy (long 2nd or 3rd) | Cavus foot focusing pressure on forefoot | Occupations requiring prolonged standing |
Chronic friction triggers perineural fibrosis, thickening the nerve and Schwann cell proliferation—pain worsens as the space becomes tighter.
| Conservative (≈ 70 % success) | Minimally Invasive | Surgical (≈ 5 – 10 %) |
|---|---|---|
| Custom orthotics with metatarsal pad (positioned just proximal to interspace) | Ultrasound-guided corticosteroid injection (pain ↓ in 60 – 80 %, lasts 3–9 mo) | Interdigital neurectomy (open dorsal approach) |
| Wide toe-box & low-heel footwear; rocker-sole option | Alcohol sclerosing injection (4 % dehydrated ethanol × 4 sessions; 70 % long-term relief) | Nerve decompression (ligament release) for athletes wanting sensation preservation |
| Activity modification (avoid sprint starts, hard-court pivots) | Radiofrequency ablation or cryoneurolysis under ultrasound | Revision surgery (rare) for stump neuroma |
| Short course NSAIDs, ice massage | Extracorporeal shock-wave therapy (emerging evidence) | — |
Systematic reviews report ~70 % symptom resolution with well-positioned metatarsal pads ± corticosteroid. Long-term success rises to ~90 % after neurectomy when conservative care fails.
Pads don’t shrink the neuroma; they shift pressure off the nerve, often eliminating pain and halting progression.
Guided low-dose injections into the interspace—not the fat pad—carry low atrophy risk. We limit to 2–3 per year.
Neurectomy removes the sensory branch, so mild numbness between toes is expected but rarely bothersome. Decompression preserves sensation but has a slightly higher recurrence risk.
Forefoot burning or that nagging marble-in-shoe feeling doesn’t have to cramp your lifestyle. Schedule a focused evaluation with North Texas Podiatry Associates to chart a personalised plan—pad to procedure—for neuroma-free steps.