Quick Summary
Morton's neuroma is a thickening of the tissue around one of the nerves that runs between your toes, causing sharp, burning pain and numbness in the ball of your foot — often described as walking on a pebble.
Our HCPC-registered physiotherapists in New Malden provide conservative, first-line care that combines hands-on manual therapy, footwear and offloading advice, and a targeted exercise programme.
Most people begin to notice change over a course of roughly 6–8 sessions across 6–12 weeks, although timeframes vary with how long your symptoms have been present and the size of the neuroma.
What Is Morton's Neuroma?
Morton's neuroma is one of the most common causes of forefoot pain, but despite its name it is not a true neuroma or a tumour. Research shows that the underlying change is benign perineural fibrosis — a thickening of the tissue surrounding a common plantar digital nerve in response to chronic irritation.
It most often affects the third intermetatarsal space (between the third and fourth toes), followed by the second space. The third space is thought to be involved most frequently because it is narrower and because the nerve there is thicker, making it more vulnerable to compression.
Why it develops
Evidence points to several overlapping mechanisms. The nerve may be compressed against the deep transverse intermetatarsal ligament each time you load your forefoot; repetitive microtrauma from walking, running and standing adds further irritation; and an inflamed bursa sitting alongside the nerve can both contribute to and mimic the condition. Footwear plays a major role, because a narrow toe box squeezes the metatarsal heads together and a raised heel shifts load forward — which is why symptoms often ease as soon as you take your shoes off.
Who it affects
Morton's neuroma is considerably more common in women and usually presents between the ages of 40 and 60. UK primary care data report an incidence of around 50 per 100,000 person-years in men and 88 per 100,000 in women, making it one of the most frequent compressive nerve conditions after carpal tunnel syndrome (Latinovic et al., Journal of Neurology, Neurosurgery & Psychiatry, 2006).
How we assess it
Diagnosis is mainly clinical. Our physiotherapists look for tenderness in the affected webspace, altered sensation in the adjacent toes, and a positive squeeze test or Mulder's click, where compressing the forefoot reproduces your symptoms with a palpable click. Where the picture is unclear or onward referral is being considered, ultrasound is usually the first-line scan because it shows the lesion clearly and allows its size to be measured; MRI is reserved for atypical presentations. We also screen for conditions that can look similar, including metatarsalgia, joint synovitis, a metatarsal stress fracture, a plantar plate tear and tarsal tunnel syndrome, and we signpost you onward where that is the right step.
Do You Experience These Symptoms?
✓ You feel a sharp, burning or shooting pain in the ball of your foot, usually between the third and fourth toes.
✓ You have the sensation of walking on a pebble, a marble or a bunched-up sock under your toes.
✓ You notice numbness, tingling or pins and needles in the affected toes.
✓ Your pain is worse in tight or high-heeled shoes and eases when you take your shoes off and massage the foot.
✓ Your symptoms flare with walking, running or prolonged standing, and settle with rest.
✓ You occasionally feel a click or a sudden give in the forefoot when you press or squeeze it.
These symptoms can be treated.
The sooner you begin, the better your chances of a smoother recovery.
What Causes Morton's Neuroma?
• Constrictive footwear
Narrow toe boxes and high heels press the metatarsal heads together and load the forefoot, squeezing the digital nerve against the intermetatarsal ligament.
This is the most consistently reported contributor, which is why changing your footwear is the first step in treatment.
• Repetitive forefoot loading
Running, court sports, dancing and jobs involving prolonged standing subject the nerve to repeated microtrauma.
Over time this irritation drives the perineural thickening that characterises the condition.
• Foot biomechanics and posture
Flat feet, high arches, bunions and hypermobility can alter how load is spread across the forefoot.
Uneven loading increases pressure on one particular webspace and makes a neuroma more likely to form there.
• Calf and ankle tightness
Limited ankle movement caused by tight calf muscles forces the forefoot to absorb more load as you push off.
This pattern amplifies forefoot pressure and is a modifiable factor we address directly in your rehabilitation.
• Sex and age
Being female and middle-aged substantially raises your risk, with UK data showing a clearly higher incidence in women.
These factors cannot be changed, but they help explain who is most affected and support earlier assessment.
How We Treat Morton's Neuroma at J&J Therapy
Hands-On Manual Therapy
Conservative care is the first-line approach for Morton's neuroma, and UK guidance supports footwear modification, metatarsal padding and activity modification before injection or surgery is considered. Our physiotherapists use gentle intermetatarsal mobilisation and distraction to open the affected webspace, mobilisation of the metatarsal heads and forefoot to improve load distribution, and soft-tissue work to the intrinsic foot muscles and plantar fascia. We combine this with calf and Achilles flexibility work, neural mobilisation where indicated, and precise offloading advice — including exactly where to position a metatarsal dome or pad, just behind the metatarsal heads, since incorrect placement can make symptoms worse. Taping and orthotic options are discussed where they are likely to help.
Shockwave Therapy*
Shockwave therapy, delivered with our Swiss Storz Medical MASTERPULS radial system, may complement your manual therapy and exercise programme when your physiotherapist identifies specific indications during assessment. Two small randomised controlled trials suggest that shockwave therapy may reduce pain in Morton's neuroma, but the evidence base remains limited and complete resolution of symptoms is not expected in every case. It is non-invasive and evidence-based, but it is not a first-line treatment for this condition, and we will only recommend it if it is appropriate for your individual presentation.
Targeted Exercise Programme
Your targeted exercise programme addresses the mechanical drivers of forefoot overload and is progressed according to your symptoms and goals. It typically includes intrinsic foot strengthening such as short-foot and toe-spread work, big-toe and forefoot mobility drills, calf stretching and progressive eccentric heel raises to restore ankle movement, and balance and proprioception training to encourage even weight distribution. We then guide gait, footwear and loading modification, and build a graded return to walking, running or sport. Many people notice improved calf flexibility within 2–4 weeks, with meaningful change in pain typically over 6–12 weeks; consistency with your home programme is the strongest predictor of progress.
When to Seek Urgent Medical Help
While most symptoms are not serious, urgent medical attention is required if you experience any of the following:
Sudden, severe forefoot pain that stops you bearing weight or makes you limp, which may indicate a stress fracture rather than a neuroma.
A toe visibly drifting upwards or sideways, which can signal a plantar plate rupture or joint instability needing prompt specialist assessment.
Redness, warmth, marked swelling or fever in the forefoot, which may suggest infection or inflammatory arthritis.
Rapidly worsening or spreading numbness, tingling or weakness, or symptoms affecting both feet, which warrant medical review.
FAQs About Morton's Neuroma
Will Morton's neuroma go away on its own?
It rarely resolves completely without any change, because the underlying nerve irritation continues while the aggravating load remains.
Symptoms do, however, often improve substantially with conservative care — footwear change, metatarsal padding, activity modification and physiotherapy — which is why UK guidance recommends trying these first.
Do I need surgery or an injection?
Not usually as a first step. Most people are managed conservatively, and corticosteroid injection or surgery are considered only when conservative care has not helped.
National guidance suggests referral if symptoms persist despite around three months of footwear modification and metatarsal padding. Both injection and surgery have supporting evidence but also carry risks, so they follow a proper trial of conservative treatment.
Is the lump a tumour — is it dangerous?
No. Despite the name, a Morton's neuroma is not a tumour and is not cancerous.
It is a benign thickening of the tissue around the nerve, formed in response to irritation. It is not dangerous, although it can be persistently painful and limit what you can do comfortably.
What shoes should I wear?
Choose a wide, rounded toe box with a low heel and a supportive but cushioned sole, and avoid narrow or high-heeled shoes that compress the forefoot.
A metatarsal pad positioned just behind the metatarsal heads can help offload the nerve. We will show you exactly where to place it, because incorrect placement can make symptoms worse.
Can shockwave therapy help my Morton's neuroma?
It may help some people as part of a wider treatment plan. Two small randomised trials suggest that shockwave therapy may reduce pain, but the evidence base is limited and complete resolution of symptoms is not expected in every case.
It is not a first-line treatment for this condition. We only offer it, using our Swiss Storz Medical MASTERPULS system, when your physiotherapist identifies specific indications during your assessment, alongside manual therapy and exercise.
This page is for general information only and does not replace professional medical advice.
Reviewed by Lavya Arigalayan, MSc, HCPC Registered Physiotherapist.
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