Morton’s neuroma is an intermetatarsal nerve problem in the forefoot. That means a pinched nerve between the long bones of the foot. It causes burning pain, tingling and odd feeling between the toes. Shoes that squeeze the forefoot often make it worse. It is most often a problem of women in the 35 to 50 age range. We confirm it with a focused exam, squeeze tests and ultrasound before anything is treated.
Morton’s neuroma is most common in women aged 35 to 50. If your forefoot pain acts like a nerve problem, get the right diagnosis first. Otherwise you waste time on the wrong fixes.
How is Morton’s neuroma diagnosed?
Morton’s neuroma diagnosis is built, not guessed. We start with a focused history and a targeted exam. Then we use imaging to confirm that the findings match, when the result will change what we do.
Clinical pattern matters. We look for symptoms that follow a nerve pattern: burning pain, tingling, and odd feeling in the forefoot. They are often worse in shoes that squeeze the width of the forefoot.
Provocative tests matter. Research on clinical tests points to three moves that most often catch the problem: the thumb index finger squeeze test, Mulder’s click, and the foot squeeze test.
Imaging supports localization. X-rays can rule out bone problems or stress injuries, but they do not confirm a neuroma. Ultrasound is often used to see a neuroma-like lump between the foot bones. How well it works depends on the skill of the person doing and reading the scan.
If your exam and imaging do not line up, we call that a failed diagnosis. It is not an excuse to keep piling on treatment. The images are normal, therefore the injury healed, therefore what remains is stress, litigation, or catastrophizing, is not a useful conclusion for forefoot pain. The useful conclusion is: you did not test the right loop.
When is an injection the right move for Morton’s neuroma?
Injections are part of Morton’s neuroma forefoot pain diagnosis and treatment, but they are not a free pass. They tend to work best when the diagnosis is concordant. That means your symptoms match what the exam and imaging show in the space between the foot bones.
Injections may include:
- Corticosteroid injection around the irritated nerve between the foot bones.
- Sclerosing injections in selected protocols, used to calm the tissue that is making the pain.
- Ultrasound-guided localization to hit the target more accurately, especially when anatomy varies.
On the evidence: a systematic review and meta-analysis pooled many studies. It found that corticosteroid injection can reduce pain compared with control. That does not promise a lasting fix for every patient. It does support a solid position. Injections can help control symptoms, and they can help confirm the diagnosis.
So when is a procedure the wrong call? When your pain does not follow the nerve pattern. When squeeze tests do not bring on your symptoms. When the space between the foot bones is not the likely source. Or when imaging points to another main driver. In those cases, the injection becomes roulette.
If you are getting care under the broader heading of interventional pain management, we treat injections as one step in a set loop. Diagnose well. Target the source. Then lock in offloading and rehab so the pain system has fewer reasons to flare up again.
And yes, people ask about nerve blocks in general. For Morton’s neuroma, the idea is like a targeted nerve block. But we keep the words specific to the nerve between the forefoot bones. Broad terms only muddy the decision.
Frequently asked questions
What does Morton’s neuroma feel like?
It feels like a nerve problem, not a bruise. Most people describe burning pain, tingling and odd feeling between the toes, in the ball of the foot. It is usually worse in shoes that squeeze the width of the forefoot. That nerve-pattern behavior is the first clue we look for on exam.
Who is most likely to get Morton’s neuroma?
Morton’s neuroma is most common in women between about 35 and 50. Shoes that squeeze the forefoot make the symptoms worse. Being in that group does not settle the diagnosis, though. Burning forefoot pain has other causes. So the pattern still has to be confirmed with an exam, squeeze tests and imaging before anything is treated.
Can an X-ray show Morton’s neuroma?
No. An X-ray can rule out bone problems and stress injuries in the foot, but it does not confirm a neuroma. Ultrasound is the test that can show a neuroma-like lump between the metatarsals (the long foot bones). Its accuracy depends on the skill of the person doing and reading it. That is why we always match imaging against the exam.
How do you confirm Morton neuroma instead of another foot problem?
Morton’s neuroma forefoot pain diagnosis and treatment starts with a focused history and exam. Squeeze tests and Mulder’s click matter most, because they bring on the symptoms. Then we use imaging, often ultrasound, to confirm the spot matches. That way you do not get treated for the wrong pain source. See foot pain evaluation for how this is evaluated.
Is ultrasound enough for Morton neuroma?
Ultrasound can support the diagnosis, but it is not enough by itself. The sound approach pairs ultrasound with the clinical pattern, because ultrasound can miss a neuroma in some cases. It can also show stray findings when the symptoms come from somewhere else. See image-guided procedures for how this is evaluated.
What is the most effective non-surgical Morton neuroma option?
Non-surgical Morton’s neuroma forefoot pain diagnosis and treatment usually begins with better shoes, offloading pads, and changes in activity. Sometimes central sensitization (an overactive pain system) or nerve sensitivity is involved. Then added steps from chronic pain treatment may be needed to break the pain loop. See hydrodissection for how this is evaluated.
Do corticosteroid injections really help Morton neuroma?
A systematic review and meta-analysis reported that corticosteroid injection lowered pain compared with control on a VAS scale. That supports a short-term benefit. It fits best when the diagnosis is concordant. It is not a promised long-term cure. See diagnostic nerve blocks for how this is evaluated.
When should someone consider surgery for Morton neuroma?
Surgery is usually considered when symptoms persist despite proper conservative and injection-based care. We weigh surgery when your exam and imaging match the nerve target between the foot bones. The expected benefits must also outweigh the risk of lasting numbness or nerve symptoms. See shockwave therapy for how this is evaluated.
To discuss your own case, request an appointment through the appointment request form, call (314) 481-5000, or text (314) 886-5902. You can review the full range of pain treatments, read about the pain management doctors in St. Louis, or find both offices on the locations page.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
