Health Insights · Physiotherapy & MSK
Morton's neuroma: burning pain in the ball of the foot
Morton's neuroma is thickening of the tissue around a nerve between the toes, usually between the third and fourth. It causes burning forefoot pain, numbness in the adjacent toes, and a characteristic sensation of a stone or fold in the sock. It responds well to treatment, and simple measures work first.
Arrange assessment rather than assuming neuroma if there is
- swelling, redness or heat across the forefoot, or fever
- pain following an injury or a sudden increase in running — possible stress fracture
- numbness spreading beyond the toes, or weakness of the foot
- night pain unrelated to activity
- a visible lump that is growing
- these symptoms with diabetes — neuropathy presents similarly
Metatarsal stress fractures, arthritis of the toe joints and diabetic neuropathy all cause forefoot pain and are managed differently. Ultrasound distinguishes them quickly.
What it feels like
- Burning, sharp or electric pain in the ball of the foot, radiating into two adjacent toes
- the sense of a pebble, marble or rucked sock underfoot
- numbness or tingling in the affected toes
- worse in tight or narrow shoes and heels, better with shoes off and rubbing the foot
- worse on walking, standing and running; relieved by rest
- sometimes a click felt when the forefoot is squeezed
First-line treatment
- Change the footwear. Wide toe box, low heel, cushioned sole. This alone resolves a proportion of cases and no other treatment works well without it.
- Use a metatarsal pad or dome, placed behind the ball of the foot rather than under it, to spread the metatarsal heads apart.
- Reduce the aggravating activity temporarily — running, standing all day, high-impact classes.
- Ice and anti-inflammatory gel after activity.
- Calf stretching and foot strengthening, which reduce forefoot loading.
Why the injection is done under ultrasound
A steroid injection into the space around the nerve is effective for a majority of people, and the effect can last many months. Done blind it frequently misses the target, and repeated injections into the fat pad cause thinning and skin lightening. Ultrasound guidance confirms the diagnosis and places the injection accurately in the same appointment, which is both safer and considerably more likely to work.
If injection does not settle it
- A second injection, usually no more than two or three in total.
- Alcohol or radiofrequency ablation of the nerve, used in some centres.
- Surgery — either releasing the ligament compressing the nerve, or removing the neuroma. Removal leaves permanent numbness between the affected toes, which most people accept readily in exchange for losing the pain.
- Recovery from surgery is around four to six weeks in a supportive shoe, with swelling for longer.
Why come to us. Forefoot pain is frequently treated on assumption. We examine the foot, perform ultrasound on site in the same appointment to confirm the neuroma and exclude a stress fracture or arthritis, and can give an ultrasound-guided injection there and then rather than sending you elsewhere and starting again. Orthopaedic and physiotherapy input under one roof, no referral needed.
Private assessment for Morton's neuroma in London
Morton's neuroma causes burning pain, numbness or a 'pebble in the shoe' feeling in the ball of the foot, and it often improves with the right measures. Our private physiotherapy clinic in London can assess and treat it with footwear advice and orthotics, and our musculoskeletal and orthopaedic team can arrange an ultrasound and guided injections where needed. Tower Bridge Hospital is on Whitechapel Road in East London, a short journey from Canary Wharf and the City, with same-day appointments and no referral required.
Morton's neuroma in London: common questions
What does Morton's neuroma feel like?
Burning or shooting pain between the toes, numbness, or the sensation of a lump or pebble underfoot, worse in tight shoes.
How is it treated?
With wider footwear, orthotics and activity changes first; injections or, rarely, surgery help persistent cases.
Do I need a scan?
An ultrasound can confirm the diagnosis and guide an injection where treatment is not helping.
Do I need a referral?
No — you can book physiotherapy directly or start with a private GP.
Scanned and injected in the same appointment
Ultrasound-guided injection on site. 7 days a week, no referral.