Morton’s Neuroma: Relief for Foot Pain and When to See a GP

Morton’s neuroma is a painful condition that affects the ball of your foot, most commonly the area between your third and fourth toes. Despite the name, it is not actually a tumour; rather, it is a thickening of the tissue around one of the digital nerves leading to your toes. This thickening occurs in response to irritation, pressure, or injury to the nerve.

In the UK, many patients describe the sensation as standing on a pebble or a folded-up sock. Because the nerve is compressed, it can lead to sharp, stinging pains or even numbness in the toes. According to NHS guidance, it is a common cause of metatarsalgia (generalised pain in the front of the foot) and is frequently seen in people who wear tight, restrictive footwear or those who engage in high-impact sports.

Unlike many other foot conditions, Morton’s neuroma rarely shows outward signs such as a lump or redness. Instead, the symptoms are almost entirely sensory. You should look out for:

• A burning sensation: Usually felt in the ball of the foot that may radiate into the toes.
• Sharp or 'electric' pain: Sudden stabs of pain when walking or putting weight on the foot.
• Numbness or tingling: A 'pins and needles' sensation in the affected toes.
• The 'pebble' sensation: A persistent feeling that something is inside your shoe or stuck under your foot.

Symptoms often worsen when wearing tight shoes or high heels and typically improve when you take your shoes off and massage the foot.

Anything that causes compression or irritation of the nerve can contribute to the development of a neuroma. In the UK, the primary culprits are:

Footwear Choices

Tight, narrow shoes or high heels can squeeze the metatarsal bones together, pinching the nerve between them. This is why the condition is significantly more common in women.

High-Impact Activities

Participating in sports that involve repetitive pounding on the feet, such as running, jogging, or court sports like tennis, can increase the risk of nerve trauma.

Foot Deformities

Existing issues such as bunions, hammer toes, high arches, or flat feet can alter the way you walk and increase the pressure on the digital nerves.

NICE (National Institute for Health and Care Excellence) guidelines suggest starting with conservative management for at least three to six months before considering more invasive options. Effective self-care includes:

• Footwear Modification: Switch to shoes with a wide toe box and plenty of room for your toes to spread out. Avoid heels higher than two inches.
• Metatarsal Pads: These are small pads placed inside the shoe to help lift and separate the metatarsal heads, taking pressure off the nerve.
• Orthotics: Custom or over-the-counter insoles can help stabilise the foot and redistribute weight.
• Activity Modification: If you are a runner, consider switching to lower-impact activities like swimming or cycling until the inflammation subsides.
• Pain Relief: Over-the-counter anti-inflammatories, such as ibuprofen, can help manage acute flare-ups, though they should not be used long-term without medical advice.

If your foot pain is persistent and does not improve with better footwear and rest, you should seek medical advice. You can speak to a GP online to discuss your symptoms and receive a preliminary assessment.

An online consultation is highly effective for:

• Discussing the duration and nature of your pain.
• Receiving guidance on which specific over-the-counter treatments are safest for you.
• Getting a sick note if your condition prevents you from standing or walking at work.
• A referral to a podiatrist or an orthopaedic specialist for further imaging, such as an ultrasound or MRI scan, which are used to confirm the diagnosis.

A GP can also help rule out other conditions like stress fractures or rheumatoid arthritis, which can sometimes mimic the symptoms of a neuroma.

If conservative measures fail, the next step usually involves clinical intervention. In the UK, the most common medical treatments include:

Corticosteroid Injections

A mixture of local anaesthetic and steroid is injected into the affected area to reduce inflammation around the nerve. This can provide relief for several months.

Sclerosant Injections

Alcohol injections are sometimes used to 'deaden' the nerve, though this is less common than steroid treatments.

Surgical Decompression

If the pain remains debilitating, a surgeon may remove a small portion of the nerve or cut the surrounding tissue to create more space. While surgery has a high success rate, it may result in permanent numbness in the affected toes.