A burning sensation in the ball of the foot. Electric-like pain travelling toward the toes. The feeling that something is stuck inside your shoe.
Then you take your shoe off — and the pressure starts to ease.
These symptoms can be associated with Morton’s neuroma, but the location of the pain alone is not enough to confirm the diagnosis.
Some patients arrive for an evaluation after months — sometimes longer — of changing shoes, reducing activities or trying different treatments without fully understanding what is causing the pain.
That is where a proper clinical assessment becomes important.
What is Morton’s neuroma?
Morton’s neuroma affects a nerve in the forefoot, most commonly between the third and fourth metatarsal bones.
Repeated irritation or compression can cause the nerve and surrounding tissue to thicken and become painful.
Despite the name, a Morton’s “neuroma” is generally not a nerve tumour. It is more accurately related to irritation and thickening of the nerve tissue.
What does Morton’s neuroma feel like?
Patients do not all describe the pain in the same way.
Some experience a burning sensation in the ball of the foot. Others describe tingling, electric shocks or numbness extending into the toes.
Another common description is the sensation of walking on a small object or pebble even though there is nothing inside the shoe.
Symptoms may include:
- Pain in the forefoot.
- Burning between the metatarsal bones.
- Tingling or numbness in the toes.
- Electric-like pain extending toward the toes.
- Pain that becomes worse in certain shoes.
- A feeling of pressure or a foreign object under the foot.
But these symptoms are not unique to Morton’s neuroma.
Forefoot pain is not always Morton’s neuroma
Pain in the same area may also be related to other conditions, including metatarsalgia, plantar plate injuries, stress fractures or joint problems.
This is why every pain under the forefoot should not automatically be labelled a Morton’s neuroma.
The evaluation usually begins with the patient’s symptoms and a clinical examination.
The podiatrist may assess:
- Where the pain is located.
- Whether pressure reproduces the symptoms.
- The position and mobility of the toes.
- Other structures of the forefoot.
- Whether another condition could explain the pain.
Imaging may also be used when clinically indicated.
At the Foot Surgery Institute – Montréal, diagnostic resources include digital radiography and musculoskeletal ultrasound, with fluoroscopy available for procedures when appropriate.
Does Morton’s neuroma always require surgery?
No.
Having Morton’s neuroma does not automatically mean surgery is necessary.
Depending on the condition, conservative treatment may first focus on reducing pressure on the nerve and forefoot.
Options may include:
- Changes in footwear.
- Metatarsal pads.
- Custom foot orthotics.
- Activity modification.
- Injections in selected cases.
The important question is therefore not simply:
“I have Morton’s neuroma. Do I need surgery?”
A better question is:
“Is the neuroma actually causing my pain, and what options remain if appropriate conservative treatment has not been enough?”
When can Morton’s neuroma surgery be considered?
When the diagnosis is established, symptoms remain significant and appropriate conservative treatments have not provided sufficient relief, a surgical evaluation may be considered.
One surgical option is excision of the Morton’s neuroma, also known as a neurectomy.
The procedure involves removing the affected portion of the nerve responsible for the symptoms.
Because the nerve is sensory, some numbness between the involved toes can remain after surgery. This is one of the points that should be discussed with the patient before deciding on the procedure.
Why the evaluation matters before surgery
Two patients can describe almost identical pain and still have completely different conditions.
The opposite can also happen: imaging may reveal a neuroma, but that does not automatically mean it is responsible for every symptom the patient is experiencing.
That is why a surgical decision should not be based on an image alone.
The assessment should bring together:
Symptoms + Clinical examination + Imaging when indicated + Response to previous treatments
Together, these elements help determine whether the nerve is truly the source of the problem and whether surgery should be considered.
Does your foot hurt mainly when you wear certain shoes?
That detail can be particularly important.
Narrow or restrictive footwear can increase compression across the forefoot and aggravate symptoms associated with Morton’s neuroma.
Some patients notice that the burning or pressure improves shortly after removing the shoe.
However, when you begin choosing every shoe around the pain, avoiding activities or regularly needing to remove your shoes for relief, it may be time to determine what is actually causing the symptoms.
Morton’s neuroma evaluation in Montréal
At the Foot Surgery Institute – Montréal, patients can be evaluated for forefoot pain, including suspected Morton’s neuroma, and discuss treatment options according to their individual condition.
When surgery is being considered, the first objective is to determine what is causing the pain and why it continues, before deciding which treatment is appropriate.
Dr. Zyad Hobeychi, Podiatrist
Dr. Anne-Louise Smith, Podiatrist
Dr. Justin Muser, Podiatrist
Foot Surgery Institute – Montréal
7777 Décarie Boulevard, Suite 120
Montréal, QC H4P 2H2
450 964-3773
info@podiatre.com
www.podiatre.com