By Ernest Sorenson, DPM – Sorenson Foot & Ankle, Magnolia, TX
If you’ve ever felt like you’re walking on a pebble, or you get burning pain and tingling in the ball of your foot that shoots into your toes, you may be dealing with Morton’s neuroma.
Morton’s neuroma is a compressive neuropathy—a type of nerve irritation—of a small nerve that runs between the long bones of your foot, most commonly between the 3rd and 4th toes. Over time, repeated pressure and irritation cause the nerve to thicken and become painful. It’s considered a degenerative change in the nerve, not a cancerous tumor.
This article is for general educational purposes only. It does not create a doctor–patient relationship and does not replace an in-person medical evaluation or diagnosis.
What Causes Morton’s Neuroma?
The core problem in Morton’s neuroma is chronic compression and irritation of the interdigital nerve under the deep transverse intermetatarsal ligament in the forefoot. Over time, this leads to nerve thickening and pain.
Common contributing factors include:
- Tight, narrow, or pointed shoes that squeeze the toes together
- High heels, which shift weight onto the ball of the foot
- High-impact or forefoot-loading activities like running or court sports
- Foot structure and alignment issues that increase pressure under the forefoot
- Spending long hours standing or walking on hard surfaces
As a foot and ankle specialist in Magnolia and Northwest Houston, Texas, I see Morton’s neuroma frequently in runners, active adults, teachers, healthcare workers, and anyone who lives in supportive footwear but still loads the forefoot all day.
Who Is More at Risk?
Certain people are more likely to develop a neuroma because of their foot type or lifestyle:
- Flat feet / hyperpronation – increase traction and compression around the nerve
- High arches – less shock absorption, more load on the forefoot
- Bunions and hammertoes – change alignment of the metatarsal heads
- People who regularly wear heels or narrow dress shoes
- Runners and athletes in impact sports
Women are diagnosed slightly more often than men, likely because of footwear patterns, though anyone can develop Morton’s neuroma.
Symptoms of Morton’s Neuroma
Common symptoms include:
- Burning or tingling in the ball of the foot
- Numbness or pins-and-needles in the toes
- A “pebble in the shoe” or “sock bunched up” feeling
- Sharp, shooting pain with walking, pushing off, or tight shoes
- Pain that improves when the shoes come off or the forefoot is massaged
If these symptoms are persistent, progressive, or affecting your daily life, it’s important to have them evaluated to confirm the diagnosis and rule out other causes of forefoot pain.
Shoe Gear That Can Trigger or Worsen a Neuroma
Certain shoes increase pressure and irritation around the nerve in the ball of the foot. These include:
- High heels (especially over 2–3 inches)
- Narrow or pointed dress shoes
- Very minimal shoes with little cushioning (in some foot types)
- Worn-out running or walking shoes with compressed forefoot cushioning
Over time, these choices can contribute to nerve irritation in someone who is already predisposed because of their foot structure or activity level.
Best Shoe Gear to Help Prevent or Calm a Morton’s Neuroma
While no shoe can guarantee prevention, smart shoe choices can reduce your risk and help symptoms once they start:
- Wide, roomy toe box so the toes can spread naturally
- Low or moderate heel height instead of high-heels
- Good forefoot cushioning to reduce impact and pressure
- Support matched to your foot type:
- Flat feet may benefit from more arch support and stability
- High-arched feet often need more cushioning and shock absorption
Many patients in our Magnolia clinic do well in running or walking shoes with a wider forefoot and soft but supportive midsole. Custom or over-the-counter orthotics often complement these changes.
Conservative Treatment Options for Morton’s Neuroma
Most Morton’s neuroma cases are treated without surgery first. Evidence-based conservative options include:
1. Footwear Changes
Transitioning to wider, cushioned shoes with a spacious toe box is often the first and most important step. Limiting time in high heels or tight dress shoes can significantly reduce irritation around the nerve.
2. Orthotics and Metatarsal Padding
Custom or prefabricated orthotics can help:
- Redistribute pressure away from the irritated nerve
- Improve alignment and reduce forefoot overload
A metatarsal pad placed just behind the ball of the foot opens up the space between the metatarsal heads, decreasing compression on the nerve and often reducing symptoms.
3. Activity Modification and Physical Measures
Temporarily reducing high-impact or forefoot-heavy activities (like sprinting, jumping, or court sports) can help calm the nerve. Ice, elevation, and calf stretches may also provide relief and improve foot mechanics.
4. Medications and Topical Therapies
When medically appropriate, short-term use of oral anti-inflammatory medications (such as ibuprofen or naproxen) may help decrease pain and inflammation.
Some patients also use topical therapies, including:
- Over-the-counter anti-inflammatory gels or creams
- Topical CBD products as an adjunct for nerve-related discomfort
Evidence for topical CBD in Morton’s neuroma specifically is still limited. It should be viewed as a supportive option rather than a primary treatment, and any new medication or supplement should be reviewed with your healthcare provider.
5. Injections
When symptoms are not well controlled with shoe changes and orthotics, injections are often considered:
- Corticosteroid injections to reduce inflammation and pain in the short to medium term
- Local anesthetic injections to help confirm the diagnosis and provide temporary relief
- Sclerosing (alcohol) injections – a series of dilute alcohol injections aimed at shrinking or disrupting the painful portion of the nerve
The exact injection plan depends on your overall health, symptoms, and goals. Some patients experience long-lasting relief with injections; others may eventually need additional options.
6. Shockwave Therapy (ESWT)
Extracorporeal Shockwave Therapy (ESWT) is a noninvasive treatment that uses targeted sound waves to stimulate healing and modulate pain in chronically irritated tissue.
Clinical studies have shown that ESWT can reduce pain and improve function in some patients with Morton’s neuroma, especially when simple conservative measures have not provided enough relief. ESWT is typically considered before surgery in appropriate cases.
When Is Surgery Considered for Morton’s Neuroma?
If symptoms remain significant and limiting despite appropriate conservative care, surgical options may be discussed. The most common procedure is a neurectomy, which removes the thickened portion of the nerve through a small incision, often on the top of the foot.
Key points about surgery include:
- Many patients enjoy good to excellent pain relief after neurectomy
- Permanent numbness in part of the affected toes is expected if the nerve is removed
- There is a risk of persistent pain or a “stump neuroma” (painful regrowth or irritation at the cut end of the nerve)
- As with any surgery, there are risks of infection, scar sensitivity, and wound complications
Because of these factors, surgery is usually reserved for patients whose pain significantly limits daily activities and who have not improved with non-surgical treatments.
Can Morton’s Neuroma Be Prevented?
Not every case can be prevented, but you can lower your risk by:
- Wearing shoes with a wide, comfortable toe box
- Limiting time in high heels or very narrow dress shoes
- Supporting your foot type with appropriate orthotics or insoles
- Maintaining a healthy body weight where possible
- Replacing athletic shoes regularly and not training through persistent forefoot pain
Foot Pain in Magnolia, TX? When to See a Podiatrist
Morton’s neuroma is common—and very treatable. Most people can significantly reduce their pain and get back to the activities they enjoy with a combination of updated footwear, targeted support, and evidence-based treatment.
If you live in Magnolia, Tomball, The Woodlands, or Northwest Houston and you’re experiencing burning forefoot pain, tingling in your toes, or that “pebble in the shoe” feeling, consider scheduling an in-person evaluation with a podiatrist in Magnolia, TX to explore which options make sense for you. Schedule from the main page via Zoc Doc or give us a call.
This blog is general health information only. It is not diagnosis, does not create a doctor–patient relationship, and should not replace a personalized exam and treatment plan by your own physician.
Dr. Sorenson