Health condition · Clinically reviewed
Morton’s neuroma, the classic third web-space electric-shock pain — modern stratified care.
A benign fibrous thickening of an intermetatarsal nerve, typically in the third web space. Wider shoes, orthotics and image-guided injections work for many; alcohol ablation and surgical excision reserved for refractory cases.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Every claim is checked against NICE, BOFAS or peer-reviewed sources you can see at the end.
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Current for 2026
Reflects current UK guidance on footwear, orthoses, ultrasound-guided injection and ablation.
Key facts
Morton’s neuroma at a glance.
The essentials, in plain English — what Morton’s neuroma is, why it causes that classic electric-shock pain, and what the evidence says actually helps.
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Definition
Morton’s neuroma is a benign perineural fibrosis of an intermetatarsal nerve — not a true tumour, despite the name.
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Location
The third web space (between the third and fourth toes) is by far the most common site.
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Who gets it
More common in women than men, with a strong link to narrow or tight-fitting footwear.
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Clinical sign
Mulder’s click — a palpable, sometimes audible click on compressing the forefoot — is the classic examination finding.
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First-line imaging
Ultrasound of the forefoot is first-line — quick, dynamic and highly accurate in experienced hands.
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Injections work
Ultrasound-guided steroid injection is highly effective for many patients, particularly if the neuroma is small.
Why this guide matters
Footwear and injections first, surgery last.
Morton’s neuroma is often treatable with wider shoes, orthoses and image-guided injection — this guide sets out that order clearly so nobody rushes to surgery too soon.
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Footwear is a real intervention
A wider toe box and a lower heel take pressure off the neuroma — the cheapest, highest-value change most people can make.
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Image-guided injections work
Ultrasound-guided steroid injection is highly effective for many patients, particularly when the neuroma is small.
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Ablation before surgery
Alcohol or radiofrequency ablation offer a specialist middle ground before considering neurectomy.
How the diagnosis is made
From electric-shock pain to a clear plan.
The steps a UK GP or podiatrist will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
Symptoms, palpation and Mulder’s click
Phase 2 · Confirming
Ultrasound, MRI and mimic exclusion
Phase 3 · Managing
Conservative first, surgical if refractory
- 01
Recognising
Symptom pattern
Burning or electric-shock pain in the forefoot, often shooting into the toes, worse in tight shoes and easing when the shoe comes off.
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Recognising
Palpate the web spaces
Direct palpation between the metatarsal heads reproduces the pain — typically in the third web space, sometimes the second.
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Recognising
Mulder’s click
Compressing the forefoot side-to-side while palpating the web space produces a click and reproduces the shooting pain — the classic sign.
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Confirming
Ultrasound of the forefoot
First-line imaging — measures the neuroma, confirms the diagnosis and guides any subsequent injection.
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Confirming
MRI if uncertain or bilateral
Reserved for atypical cases, bilateral disease, or where a different soft-tissue mass needs to be excluded.
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Confirming
Rule out metatarsalgia mimics
Consider MTP joint synovitis, stress fracture, Freiberg’s disease and tarsal tunnel syndrome — they can all look similar.
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Managing
Foot and ankle surgery referral
For refractory cases — alcohol ablation, radiofrequency or surgical excision (neurectomy) with a specialist.
Typical timeline: 2–4 weeks from first appointment to a settled plan.
Symptoms
What Morton’s neuroma actually feels like.
The pattern is more telling than any single symptom — electric-shock or burning pain in the forefoot, worse in tight shoes and easing when they come off.
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Electric-shock pain
A sudden, sharp, shooting pain in the forefoot that radiates into the toes — the classic Morton’s symptom.
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Burning pain
A hot, burning quality of pain between the metatarsal heads, particularly with weight-bearing.
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Toe numbness
Numbness or altered sensation in the adjacent sides of the two toes served by the affected nerve.
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Mulder’s click positive
A palpable click on side-to-side forefoot compression that reproduces the pain — a specific clinical sign.
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Wider forefoot symptoms
Symptoms may feel diffuse across the ball of the foot, not always sharply localised to one web space.
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Metatarsalgia overlap
Pain and callus under the metatarsal heads often coexist and can muddy the picture.
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Recurrent symptoms
Symptoms often wax and wane over months to years, flaring with tight shoes or long standing.
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Red flag
Bilateral neuromas alongside polyneuropathy signs — investigate for a systemic cause rather than treating locally.
Treatment
How Morton’s neuroma is treated in the UK.
A staged approach — footwear and orthoses first, then image-guided injection, then ablation, with surgical excision reserved for refractory disease.
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Wide toe-box shoes
The single most useful first step — a wider forefoot, low heel and soft upper takes pressure off the neuroma.
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Metatarsal dome / bar insoles
Off-loads the metatarsal heads and spreads them apart — simple, cheap and often surprisingly effective.
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Ultrasound-guided steroid injection
Highly effective for many patients — image guidance ensures the steroid reaches the neuroma, not the surrounding fat.
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Repeat injection if response
A second image-guided injection is reasonable if the first gave meaningful, sustained relief.
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Alcohol ablation (specialist)
Ultrasound-guided injection of dilute alcohol that chemically ablates the nerve — used in specialist hands for refractory cases.
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Radiofrequency ablation
Image-guided thermal ablation of the neuroma — an alternative to alcohol in specialist centres.
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Neurectomy (surgical excision)
Surgical excision of the neuroma — reserved for refractory cases when conservative and injection therapy have failed.
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Post-op rehab and orthotics
Structured rehab, wound care and ongoing orthotic support after any surgical procedure to reduce recurrence risk.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP, podiatrist or foot and ankle team knows your history and can tell you which parts apply to you. If in doubt, get seen.
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British Orthopaedic Foot and Ankle Society (BOFAS). Patient information and clinical standards.
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NICE CKS. Morton’s neuroma — diagnosis and management.
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Royal College of Podiatry. Guidance on forefoot pain and neuromas.
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American Orthopaedic Foot & Ankle Society (AOFAS). Patient information on Morton’s neuroma.
Red flags
When forefoot pain is not just a Morton’s neuroma.
Most forefoot neuromas settle with staged conservative care. These are the situations where a different diagnosis needs to be considered.
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Bilateral neuromas + neuropathy
Bilateral forefoot neuromas alongside peripheral neuropathy signs — investigate for a systemic cause rather than assuming isolated neuromas.
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Post-op stump neuroma
New burning or electric-shock pain months after neurectomy suggests a stump neuroma and needs surgical review.
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Recurrent Morton’s after excision
True recurrence at the same site after surgical excision — needs specialist re-imaging and surgical opinion.
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Complex regional pain syndrome
Disproportionate pain, swelling, colour and temperature change after any forefoot intervention — needs a broader pain assessment, not more injections.
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Diabetic neuropathy overlap
Forefoot pain in a person with diabetes may be neuropathic rather than a neuroma — treat the underlying disease as well as the local site.
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Rheumatoid forefoot
Metatarsalgia in known or suspected rheumatoid arthritis needs a rheumatology review — not a neuroma injection first.
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Post-injection skin atrophy
Localised skin thinning, dimpling or pigment change after steroid injection — flag to the injecting clinician and avoid repeated injections at that site.
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Failed 6-month conservative therapy
Persistent, function-limiting symptoms despite six months of good footwear, orthoses and injection — time for a foot and ankle surgical opinion.
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Suspected soft-tissue mass differential
An enlarging or atypical forefoot mass on imaging — ensure an alternative soft-tissue diagnosis has been formally excluded.
Living with it
A nuisance condition, but a very manageable one.
Four things that make the biggest difference day to day — footwear, orthoses, load management and patient review.
A quiet reminder
Consistency beats intensity, every time.
Small, steady changes — kept up for months — do more than a heroic week that does not last.
- 01 Footwear
Wider shoes, lower heels
A wider toe box and a lower heel take pressure off the neuroma — the highest-value change you can make day to day.
- 02 Orthoses
Use the metatarsal dome
Small, targeted insoles that lift and spread the metatarsal heads — worn consistently, they make a real difference.
- 03 Load
Modify long days on feet
Break up prolonged standing, alternate footwear and consider a rest day after high-impact activity while flaring.
- 04 Reviews
Reassess in weeks, not days
Give conservative measures 6–12 weeks before deciding they have failed — then consider injection or specialist referral.
Frequently asked
Everything we get asked about Morton’s neuroma.
Quick answers on imaging, injections, ablation, surgery and when to seek help.
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Is Morton’s neuroma actually a tumour?
No. Despite the name, Morton’s neuroma is a benign fibrous thickening of an intermetatarsal nerve — a perineural fibrosis — not a true tumour. It does not spread and does not turn cancerous.
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Why does it usually affect the third web space?
The third web space is anatomically the most common site because the medial and lateral plantar nerves converge here, creating a thicker nerve that is more prone to irritation between the metatarsal heads.
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Do I need an MRI?
Usually not. Ultrasound of the forefoot is first-line — it is quick, dynamic and highly accurate. MRI is reserved for uncertain diagnoses, bilateral cases, or when an alternative soft-tissue mass needs to be excluded.
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How effective is a steroid injection?
Ultrasound-guided steroid injection is highly effective for many patients, particularly when the neuroma is small. A second injection is reasonable if the first gave meaningful, sustained relief.
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What is alcohol ablation?
Alcohol ablation is an ultrasound-guided injection of dilute alcohol that chemically ablates the nerve. It is used in specialist hands for refractory cases as an alternative to surgery.
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What is the red flag I should not ignore?
Bilateral neuromas alongside signs of a wider peripheral neuropathy — investigate for a systemic cause. New burning pain after previous neurectomy also needs surgical review to exclude a stump neuroma.
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