Morton's Neuroma - Symptoms, Cause, Diagnosis and Treatment

The diagnosis Morton's neuroma is a musculoskeletal problem that causes pain on the upper side of the foot between the toes. The condition is due to a pinching of the nerves between the toes.

Morton's neuroma most often occurs between the second and third toes - or between the third and fourth toes. It is more correct to say that the squeezing takes place between the metatarsal legs in the forefoot. The pain may be occasionally sharp, shock-like and there may also be numbness or decreased sensation in the affected area. Another name for the diagnosis is morton syndrome. Morton's neuroma affects the intermetatarsal plantar nerve - also known as the interdigital nerve. A neuroma can be a benign accumulation of nerve fibers or a nerve tumor (note: Morton's neuroma is almost always benign).

- Can be treated conservatively

An important point to make is that the vast majority of cases can be treated conservatively without surgery. Studies have shown a well-documented effect, in the form of significant pain reduction, when using pressure wave therapy (1). This effect is due to the fact that the pressure waves break down damaged tissue, which is less elastic and mobile, and that it stimulates better blood circulation in the area (angiogenesis). Unlike a surgical procedure, pressure wave therapy will not lead to scar tissue and potential pain due to this scar tissue. Precisely for this reason, we recommend that you try a course of treatment of 5-7 pressure wave treatments before considering surgery.

In this article, we will review, among other things:

Causes of Morton's neuroma

2. Symptoms of Morton's neuroma

3. How to diagnose Morton's neuroma

4. Treatment of Morton's neuroma

A) Conservative Treatment

B) Invasive Treatment

5. Self-Measures and Exercises Against Mortons

Scroll down for to watch a training video with exercises which can help you with Morton's neuroma.

TIP: Many people with Morton's neuroma valgus like to use toe pullers og specially adapted compression socks (the link opens in a new window) to increase circulation and limit the load on the nerve clamp between the toes.

VIDEO: 5 Exercises against Morton's neuroma

This video shows you five exercises that contribute to increased blood circulation in the feet, a stronger arch and generally improved functionality. The exercise program may be suitable for those with Morton's neuroma, but always remember to take your pain picture and day form into consideration.

Feel free to subscribe on our Youtube channel - and follow our page on FB for daily health tips and exercise programs.

Causes of Morton's neuroma

The most common cause of Morton's neuroma is that the forefoot has been overloaded or incorrectly loaded for a long time. Tight footwear that has pressed the front part of the foot together can also be a strong contributing factor. Increased load can result from activity over endurance, increased body weight, poor footwear and unfortunate incorrect loads. Loads above the body's load capacity will lead to the build-up of harder damage tissue in the forefoot. Over time, this will provide less flexibility and mobility in the area. Reduced movement of the front joints of the foot can cause mechanical irritation of the nerves between the toes.

Plantar nerve overview - Photo Wikimedia

Also read: 7 Early Signs of Gout

Symptoms of Morton's neuroma

Some of the most common symptoms of Morton's neuroma are weight loss pain, often after a short period of time. The pain presentation varies from person to person, however electric pain, bumps, walking on razor blades or have a rock in your shoe, is often used in explanations from patients. One burning sensation or numbness are also fairly common symptoms. It should be noted that Morton's neuroma may also be asymptomatic, as shown in a study by Bencardino et al in 2000.

Common symptoms of Morton's neuroma may include:

• Burning pain in the front of the foot that can also send searing pain forward towards the toes.

• A tingling or rushing sensation between the affected toes - usually between the third and fourth toes.

• Numbness and lack of feeling in the affected toes.

3. Diagnosis of Morton's neuroma

The clinician will first examine for signs of inflammation, infection, deformities, blood tests or biomechanical findings. Then a special test called is often used Mulder's sign, where the clinician presses the forefoot together to see if this recreates the symptoms. If it recreates the pain in the foot, then this is a positive test. Other possible causes of neuroma-like symptoms are capsulitis, stress fracture, intermetatarsal bursitis or Freiberg's disease. However, due to Morton's relatively characteristic symptoms and clinical signs, a modern clinician will be able to recognize the diagnosis.

Who Can Help Me Diagnose Morton's Neuroma?

In our recommendations, we will always use publicly authorized professions - this is because these are professions that are regulated by Helfo and also covered by the Norwegian Patient Injury Compensation (NPE). Unauthorized professions also do not have title protection, and in theory, therefore, anyone can call themselves a naprapath or acupuncturist - until these professions are hopefully regulated and authorized. This will also ensure that naprapaths, who only call themselves without education, are no longer allowed to call themselves that. But for assessment and treatment of foot and ankle problems, we recommend a modern chiropractor, physiotherapist or manual therapist. Make sure you do good research beforehand and check that they are actually working with Morton's neuroma. If desired, you can also see about some of our clinics and partners is near you.

Imaging diagnostic examination of Morton's neuroma (X-ray, MRI, CT or ultrasound)

Here it is first and foremost important to mention that in the majority of cases one manages without imaging. However, if it is medically indicated, an X-ray will normally be taken in the first instance. This is to rule out degenerative changes in joints (Osteoarthrtitis), local focal bone growth or stress fractures are the cause of the pain. Diagnostic ultrasound (sonography) can find thickening of the interdigital nerve, but is also open to human error. If this thickness is more than 3mm, then this is compatible with Morton's neuroma. MR picture can, like ultrasound, provide a good overview of both bone and soft tissue in the foot, and is considered the best diagnostic imaging option when it comes to diagnosing Morton's neuroma.

Example: MR image of Morton's neuroma

MR image of Morton's neuroma between third and fourth metatarsal - Photo Wikimedia commons

4. Treatment of Morton's neuroma

• A) Conservative Treatment of Morton's Neuroma

- Pressure wave treatment

- Physical Treatment (Including joint mobilization and joint manipulation)

- Sole adjustment and footwear

- Self-measures (Hallux valgus support and compression clothing)

• B) Invasive Treatment of Morton's Neuroma (considered more risky)

- Cortisone injection

- Surgical intervention (Neurotomy)

- Alcohol injection (Treatment method used less frequently as of today)

Conservative Treatment of Morton's Neuroma

Very many patients manage without invasive treatment measures. Conservative treatment is thus treatment methods that have almost zero risk. A normal conservative treatment plan can often consist of joint mobilization of the foot, as well as pressure wave treatment aimed focused at the neuroma itself. As mentioned at the beginning of the article, pressure wave therapy has a well-documented effect on pain due to Morton's neuroma (1). Here it is also very important to mention that chiropractic joint mobilization or joint adjustment of the forefoot has, in meta-analyzes, almost as good an effect as cortisone injection when it comes to functional improvement and pain reduction (2).

Precisely for this reason, it is appropriate to combine joint mobilization and pressure wave therapy with conservative treatment of Morton's neuroma. If you combine this with your own measures and exercises, you can achieve very good results. Avoid bad footwear that puts a lot of pressure on the forefoot, perform stretching and strength exercises for the foot, and feel free to use toe pullers (see example here - the link opens in a new window) or compression socks when you recover. The latter two can contribute to better blood circulation and maintenance of space between the toes. Better space between the toes can help relieve the pinched nerve.

Self-measures: Toe extensor / hallux valgus support

In the picture above you see what is called a toe puller (link opens in new window), also occasionally called hallux valgus support. The purpose of these is to prevent the big toe from falling against the other toes - and thus compress the areas between the toes. Many people with Morton's neuroma report that they experience symptom relief when using this self-measure. You can read more about the product (and similar products) by clicking on the image or link above. A cheap self-measure that may be worth a try for you who are bothered by Morton's neuroma.

Sole Fitting and Cushioned Shoes

Misalignments in the foot and ankle can be directly related to incorrect loading of the foot - which in turn is linked to an increased incidence of Morton's neuroma. Particularly significant overpronation is linked to both Hallux valgus and Morton's neuroma. We recommend that you have your foot and ankle function checked by an expert who can refer you (eg chiropractor, physiotherapist or manual therapist) for further public sole adaptation. Before paying in expensive judgments, we recommend that you try lightweight, inexpensive sole posts and see if you think this will have a positive effect in a matter of weeks. If you think it works, then it may be helpful to step up to professional sole posts.

We also point out that some overpronation in the foot is quite common - and that aids such as adapted soles can mean that one may not address the main problem (for example, significant weakness in the foot muscles). These days, there are also shoes with abnormally strong cushioning. The truth is that these shoes take away the work tasks from your feet, which in turn respond to becoming weaker and having poorer load capacity. In the end, you risk becoming completely dependent on your cushioned shoes. This can easily be compared to a back corset - an aid that has been almost completely abandoned, as it was seen that this led to weakness and muscle loss in the back muscles.

Read more: Pressure Wave Therapy - Something for Your Morton's Neuroma?

Invasive Treatment of Morton's Neuroma

Unfortunately, not all patients respond to conservative treatment - and then more frequent lye is often needed. Of the most common procedures, we find cortisone injection. Such injections mixed with anesthetic should only be given with ultrasound guidance. If your clinician says they do not need ultrasound guidance, we strongly recommend that you find another therapist. Here we talk a little more in detail about alcohol injection, cortisone injection and neurotomy (surgery).

alcohol Injection

This is an alternative if conservative treatment fails. An alcohol mixture (4%) is injected directly into the neuroma, causing a poisoning of the fibrous nerve tissue - and then a possible gradual improvement in the form of reduced symptoms. The treatment must be repeated 2-4 times with 1-3 weeks between injections. Studies have actually shown close to 60% success rate for this type of injection, which is similar or higher than surgical removal of the nerve - but with fewer side effects. It has also been seen in studies that if the injection is guided with ultrasound then the chance of a positive outcome is considerably higher.

Cortisone Injection

Cortisone injections (most often mixed with anesthetic) can in some cases reduce inflammation and provide symptom relief. Unfortunately it does not work at all and among these you can see that the pain and inflammation return after a few weeks or months. As is well known, cortisone can only be used a limited number of times, as it is known that it leads to degenerative destruction of ligaments and soft tissues. The procedure should only be performed with ultrasound guidance.

Neurotomy (surgical removal of nerve tissue)

Last resort if all other interventions fail. In this operation, an attempt is made to remove the affected nerve tissue. This results in scar tissue and in 20-30% of the surgeries you see a relapse due to damaged tissue in the area. When operating in the feet, there is always talk of a long recovery time and a high chance of getting permanent changes in the foot.

Also read: 7 Natural Pain Relief Measures against Gout

5. Self-measures and Exercises against Morton's neuroma

Studies have shown that, in addition to conservative treatment, strengthening the foot muscles can also help increase the load capacity of Morton's neurons (3). In the video shown earlier in the article, you see a suggestion for an exercise program that can give you better foot function. Otherwise we also recommend this exercise program that strengthens both the foot and the ankle (the link opens in a new window).

Do You Want a Consultation or Do You Have Questions?

Feel free to contact us at YouTube or Facebook if you have questions or the like regarding exercise or your muscle and joint problems. You can also see an overview of our clinics via the link here if you want to book a consultation. Some of our departments for the Pain Clinics include Eidsvoll Healthy Chiropractor Center and Physiotherapy (Viken) and Lambertseter Chiropractor Center and Physiotherapy (Oslo). All our clinics are equipped with state-of-the-art treatment devices - including pressure wave machines and laser devices. With us, professional competence and the patient are always most important.

Also read: 4 Exercises against Plantar Fascitt

Next page: Foot pain (Great Guide)

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Sources and Research:

1. Seok et al, 2016. J Am Podiatr Med Assoc. 2016 Mar; 106 (2): 93-9. doi: 10.7547 / 14-131. Extracorporeal Shockwave Therapy in Patients with Morton's Neuroma A Randomized, Placebo-Controlled Trial.

2. Matthews et al, 2019. The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Morton's neuroma): a systematic review and meta-analysis.

3. Yoo et al, 2014. Effect of the Intrinsic Foot Muscle Exercise Combined with Interphalangeal Flexion Exercise on Metatarsalgia with Morton's Toe. J Phys Ther Sci. 2014 Dec; 26 (12),

Bencardino J, Rosenberg ZS, Beltran J, Liu X, Marty-Delfaut E (September 2000). "Morton's neuroma: is it always symptomatic?". AJR Am J Roentgenol 175 (3): 649–53. doi:10.2214/ajr.175.3.1750649.

Frequently Asked Questions about Morton's neuroma:

Is Morton's neuroma a form of rheumatism?

No, Morton's neuroma is not a form of rheumatism. As mentioned in the article: "Morton's neuroma affects the interdigital nerve."

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