Morton's Neuroma: That Strange Pebble Feeling Between Your Toes

Imagine standing up and feeling like there is a pebble stuck inside the ball of your foot, except there is nothing there. That phantom lump, often with burning, tingling, or numbness spreading into two neighboring toes, is the hallmark of Morton's neuroma.

A Morton's neuroma is not actually a tumor. It is a thickening of the tissue around one of the small nerves that run to the toes. It sits between the metatarsals (the long bones behind the toes). It happens most often in the third interspace, the gap between the third and fourth toes counting from the big toe. According to the American Academy of Orthopaedic Surgeons, the condition affects women up to ten times more often than men, largely because of footwear.

What Causes a Morton's Neuroma?

Repeated squeezing of the nerve is the main driver. Tight shoes, especially narrow dress shoes and high heels, press the metatarsal heads together and pinch the nerve between them. Over time, scar-like tissue builds up around the nerve, and a cycle of pressure and irritation sets in.

Other contributors include bunions and hammertoes that crowd the forefoot. High-impact sports. Long hours of standing. And mechanical patterns such as flat feet and overpronation (a foot that rolls inward too far with each step).

Symptoms to Watch For

A Morton's neuroma usually starts as an on-and-off nuisance. A vague sense of "something" under the ball of the foot. Occasional tingling. Relief the moment you take your shoes off. As the thickening grows, the symptoms escalate. Sharp shooting pain. Lasting numbness. And the odd feeling that your sock is bunched up under the ball of your foot when it is not.

A telltale sign: the pain is worse in shoes and better barefoot or in wide, flat shoes.

How We Diagnose and Treat Neuromas

Treatment is stepped, matched to how severe the problem is:

• Footwear changes and metatarsal pads (small pads that spread the long bones apart) take pressure off the nerve right away.
• Custom orthotics (prescription shoe inserts) address the mechanical pattern that helped create the neuroma. Learn about custom orthotics.
• Shockwave therapy (sound-wave treatment) is an option we use for selected neuromas to calm the irritated tissue without an injection. We are candid that its evidence base for neuromas is younger than it is for heel pain. Learn about shockwave therapy.
• Corticosteroid injections can quiet the inflammation in a moderate neuroma.
• Minimally invasive decompression, done in our office under local anesthesia (numbing medicine while you stay awake), is reserved for cases that resist everything simpler. A large or recurrent neuroma that needs open removal is referred. Learn about minimally invasive surgery.

The Bottom Line

That pebble feeling is not something you have to live with. Morton's neuroma is a well-understood problem with sensible treatments at every stage, from a change of shoes to a small office procedure. Explore our podiatric services.