MIS SURGERY · MORTON’S NEUROMA · ALICANTE

Morton’s Neuroma: Stop That Burning Sensation in Your Foot

Accurate ultrasound diagnosis. Conservative treatment and MIS surgery. You walk the same day.

Do you feel a sharp pain or burning sensation between your toes when you walk? Do you need to take off your shoes immediately and massage your foot to relieve the discomfort? Does it feel like you’re walking on a stone or a marble? You likely have Morton’s neuroma. At Clínica San Román, we diagnose it with an ultrasound during your first visit and offer you personalized treatment —ranging from custom insoles to minimally invasive surgery under local anesthesia, without hospitalization.

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Treatment of Morton's Neuroma — Clínica San Román Alicante

Backed by 45 years of experience

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What is Morton’s neuroma?

Morton’s neuroma (or plantar interdigital neuroma) is a benign fibrous thickening of the interdigital nerve in the foot, not a tumor. It occurs when the nerve that runs between the heads of the metatarsal bones is repeatedly compressed and irritated, leading to a chronic inflammatory reaction with perineural fibrosis (scar tissue around the nerve).

It most commonly affects the third intermetatarsal space (between the third and fourth toes), although it can also occur in the second space (between the second and third toes). It is four times more common in women than in men, especially among those aged 40 to 60, and is closely linked to the wearing of tight-fitting or high-heeled shoes.

It was first described by Thomas G. Morton in 1876. Despite its name, it is not a true neuroma (nerve tumor), but rather degenerative perineural fibrosis. The nerve becomes inflamed, thickens, and gets trapped between the metatarsals, causing intense pain that forces many patients to stop and take off their shoes.

Anatomy of Morton's Neuroma — Compressed Interdigital Nerve

Symptoms of Morton's neuroma — pain and a burning sensation between the toes

Symptoms: How can you recognize Morton’s neuroma?

The symptoms are very characteristic and are usually described in similar terms by most patients:

A sharp, stabbing pain or burning sensation between the third and fourth toes (or between the second and third toes) that occurs when walking, especially in tight shoes
A sensation of having a “pebble in your shoe” or walking on a marble—as if you had a lump inside your foot
Numbness or tingling in the affected fingers — a sign that the nerve is compromised
An urgent need to take off one’s shoes and massage the area for relief—many patients report taking off their shoes right in the middle of the street
Pain that improves with rest and when walking barefoot — when the pressure on the nerve is relieved, the discomfort subsides
Progressive worsening — over time, pain occurs with less physical activity and may persist even at rest

💡 Mulder’s test: If, when you squeeze the ball of your foot sideways with one hand and press the space between the metatarsals with the other, you feel a painful “click” and your symptoms return, this is highly suggestive of Morton’s neuroma. We perform this test during the initial consultation.

What causes Morton’s neuroma?

A neuroma develops when the plantar interdigital nerve is repeatedly compressed between the heads of the metatarsal bones and the transverse metatarsal ligament that connects them. This chronic compression causes inflammation, fibrosis, and thickening of the nerve. Contributing factors include:

👠 Footwear

Narrow or pointed shoes that compress the forefoot laterally and restrict space for the nerves
High heels (> 5 cm) that shift body weight toward the forefoot, increasing pressure on the metatarsal heads
Sports shoes that are too tight or have laces that are too tight in the forefoot area

🦶 Biomechanics and anatomy

Flatfoot or overpronation — when the arch collapses, the metatarsal bones move closer together and compress the nerve
Forefoot deformities —bunions (hallux valgus) and claw toes—alter biomechanics and increase pressure in the intermetatarsal space
Anatomy of the third space — the third space nerve receives fibers from two nerve branches (the medial and lateral plantar nerves), making it thicker and more susceptible to compression

⚡ Activity

High-impact sports —running, tennis, padel, ballet, and activities that involve repeated stress on the forefoot
Prolonged standing —especially in ill-fitting shoes
Repetitive microtrauma in the metatarsal region during walking

Diagnosis: Ultrasound at the first visit

The clinical diagnosis of Morton’s neuroma is usually quite clear based on characteristic symptoms and a physical examination. However, confirmation through imaging is essential for treatment planning:

🔍 Clinical examination

Mulder’s test (lateral compression of the forefoot + pressure on the intermetatarsal space): a palpable, painful click is highly specific. We also perform toe sensitivity tests and a comprehensive biomechanical assessment of the forefoot.

🔊 Musculoskeletal ultrasound

Ultrasound is just as accurate as an MRI for detecting Morton’s neuroma, and it is faster, more cost-effective, and can be performed right in the doctor’s office. It allows for confirmation of the diagnosis, precise localization of the neuroma, and measurement of its size (which is key to determining the treatment).

📷 Foot X-ray

Although an X-ray does not show the neuroma (since it is soft tissue), it is useful for ruling out associated bone conditions —such as overuse metatarsalgia, Freiberg’s disease, and stress fractures—and for evaluating the metatarsal alignment and the biomechanics of the forefoot.

Treatment of Morton’s neuroma at Clínica San Román

We use a stepwise, evidence-based approach tailored to the size of the neuroma, the severity of the pain, and the response to previous treatments:

Step 1 — Conservative treatment

Custom insoles with a metatarsal pad (dome pad) that separates the metatarsal heads and reduces pressure on the nerve
New shoes — wide fit, low heel (
Exercises to strengthen the intrinsic muscles of the foot to improve forefoot stability

Step 2 — Ultrasound-guided injection

Ultrasound-guided corticosteroid injection — the medication is injected directly into the neuroma area under ultrasound guidance for maximum precision. Protocol: 1–3 injections spaced 4–6 weeks apart
Ultrasound-guided pulsed radiofrequency ablation — in selected cases, with success rates of 80–85% according to published evidence

Step 3 — Minimally invasive neurectomy

MIS neurectomy via an interdigital approach — removal of the neuroma through a 1–2 cm incision, without the need to cut the transverse metatarsal ligament
Local anesthesia — no hospitalization, no general anesthesia
Immediate ambulation in postoperative shoes
Results: Significant improvement on the AOFAS and VAS pain scales over the long term (mean follow-up of > 4 years)

Minimally invasive neurectomy for Morton's neuroma

Treatment Options: A Comparison

The choice depends on the size of the neuroma, the severity of the pain, and the response to previous treatments.

Feature	Insoles + Footwear	Echoguided infiltration	Radiofrequency	MIS Neurectomy
Indication	First row (all)	Conservative failure	Selected cases	Conservative treatment failure ≥ 3–6 months
Invasiveness	None	Minimum (needle)	Minimum (needle)	Laparoscopy (1–2 cm incision)
Anesthesia	Not applicable	Local (period)	Local	Digital store
Sessions	Continuous use	1–3 (every 4–6 weeks)	1–2 sessions	1 presentation
Wandering	Immediate	Immediate	Immediate	Immediate (postqx footwear)
Resume activity	Immediate	24–48 hours	48–72 hours	3–4 weeks
Estimated effectiveness	40-50%	60-70%	80-85%	85-90%
Result	Relief while wearing	Temporary/permanent	Extended	Final

* The percentages are based on published evidence (Valisena et al. 2021, Lizano-Díez et al. 2017). Individual results may vary.

Advantages of minimally invasive neurectomy

When surgery is necessary, our MIS technique using an interdigital approach offers advantages over traditional open surgery:

🚶

You walk the same day

Immediate walking in postoperative shoes. No crutches, no wheelchair

💉

Local anesthesia

No risks associated with general anesthesia. No hospitalization or fasting required

🔬

Preserves biomechanics

Absence of the transverse intermetatarsal ligament — maintains forefoot stability

⏱️

Rapid recovery

Regular shoes after 3–4 weeks. Sports activities after 6–8 weeks

📊

Long-term results

85–90% satisfaction rate. Significant improvement in AOFAS scores with follow-up > 4 years

✂️

Minimal incision

1–2 cm between the toes. Virtually invisible scar

Do you feel a burning sensation or pain between your toes?

Morton’s neuroma is a condition that progressively worsens if left untreated. What starts as occasional discomfort can turn into constant pain that prevents you from walking, playing sports, or enjoying your daily life. However, there are effective treatments available —and the sooner it is diagnosed, the better the results.

At Clínica San Román, Dr. Israel San Román and Dr. José Manuel San Román offer a free evaluation that includes a diagnostic ultrasound to confirm the neuroma and recommend the most appropriate treatment.

📍 Downtown Alicante · 📞 +34 965 921 156 · 📧 info@clinicasanroman.com

Podiatrist appointment — free evaluation at Clínica San Román

Frequently Asked Questions About Morton’s Neuroma

We answer the most common questions. If your question isn’t listed here, please contact us and we’ll get back to you with no obligation.

🔬 About the pathology.

Is Morton’s neuroma a tumor?

No. Despite its name, Morton’s neuroma is not a tumor. It is a benign fibrous thickening (perineural fibrosis) of the interdigital nerve. It is caused by chronic compression and irritation of the nerve, not by abnormal cell growth. It is not cancerous and does not spread to other parts of the body.

Is it possible to have a neuroma in both feet?

Yes. Bilateral involvement is relatively common, especially in patients with predisposing biomechanical factors (flatfeet, overpronation) or who regularly wear tight-fitting shoes. It is also possible to have neuromas in two intermetatarsal spaces on the same foot (the second and third spaces), although this is less common. In these cases, treatment must address both lesions.

Why does it hurt more when I wear heels or tight shoes?

Tight-fitting shoes compress the heads of the metatarsal bones laterally, reducing the space available for the nerve and increasing pressure on it. High heels shift body weight toward the forefoot, multiplying the force on the neuroma area. That is why most patients experience immediate relief when walking barefoot or in wide, flat shoes.

🏥 Treatment and Surgery

Can Morton’s neuroma be cured without surgery?

Yes, in many cases. Conservative treatment (insoles with metatarsal pads, changing footwear, ultrasound-guided corticosteroid injections) is effective in approximately 60–70% of patients with small to moderate-sized neuromas (

Does Morton’s neuroma surgery hurt?

The neurectomy is performed under digital local anesthesia, so no pain is felt during the procedure. After surgery, discomfort is moderate for the first 3–5 days and is managed with oral pain medication. Most patients report immediate relief from the burning sensation and shooting pain they experienced before surgery. A small area of numbness may remain between the affected toes, which generally does not cause functional discomfort.

Does your foot go numb after surgery?

Neurectomy involves removing a segment of the thickened nerve, which results in an area of hypoesthesia (reduced sensitivity) in the skin between the two affected fingers. In practice, most patients report that this loss of sensation is mild and does not cause functional problems. The elimination of the shooting pain more than compensates for the slight reduction in sensation between the fingers.

🏃 Recovery and prevention

How long does recovery take after surgery?

Patients can begin walking in postoperative shoes immediately. Dressings are changed for 10–14 days. Normal footwear can be worn again after 3–4 weeks. Sports activities are gradually resumed between 6 and 8 weeks. Full recovery, with the ability to wear any type of footwear (including moderate heels), is usually achieved in 2–3 months.

Can a neuroma come back after surgery?

Recurrence after neurectomy is rare (estimated at 3–5% of cases). However, a stump neuroma may form at the proximal end of the severed nerve. To minimize this risk, we perform the nerve section in an area with less mechanical pressure. It is important to continue wearing appropriate footwear and insoles after surgery to protect the forefoot.

What can I do to prevent Morton’s neuroma?

The most effective preventive measures are: wearing shoes with a wide last and a spacious toe box that do not compress the forefoot; avoiding high heels (> 3–4 cm) for prolonged periods; using insoles with metatarsal pads if you have risk factors (flatfoot, bunion); performing exercises to strengthen the intrinsic muscles of the foot; and varying the type of footwear throughout the day to avoid maintaining the same pressure on the forefoot for hours.

📚 Scientific references (PubMed)

Valisena S, Petri GJ, Ferrero A. Minimally invasive neurectomy for Morton’s neuroma using an interdigital approach. Long-term results. Foot Ankle Surg. 2021;27(8):930-934. doi:10.1016/j.fas.2021.04.001. PubMed 33945999
Lizano-Díez X, Ginés-Cespedosa A, Alentorn-Geli E, et al. Morton’s interdigital neuroma: an instructional review. EFORT Open Rev. 2019;4(1):14-24. doi:10.1302/2058-5241.4.180025. PubMed 30800482
Pace A, Scammell B, Dhar S. The outcome of Morton’s neurectomy in the treatment of metatarsalgia. Int Orthop. 2010;34(4):511-515. doi:10.1007/s00264-009-0812-3. PubMed 19529934
Coughlin MJ, Pinsonneault T. Surgical treatment of interdigital neuroma. Foot Ankle Int. 2001;22(4):347-352. doi:10.1177/107110070102200413. PubMed 11354449
Jain S, Mannan K. The diagnosis and management of Morton’s neuroma: a literature review. Foot Ankle Spec. 2013;6(4):307-317. doi:10.1177/1938640013489343. PubMed 23811947
Sharp RJ, Wade CM, Hennessy MS, Saxby TS. The role of MRI and ultrasound imaging in Morton’s neuroma and the effect of lesion size on symptoms. J Bone Joint Surg (Br). 2003;85(7):999-1005. doi:10.1302/0301-620X.85B7.12633. PubMed 14516034
Markovic M, Crichton K, Read JW, Lam P, Slater HK. Effectiveness of ultrasound-guided corticosteroid injection in the treatment of Morton’s neuroma. Foot & Ankle International 2008;29(5):483-487. doi:10.3113/FAI.2008.0483. PubMed 18510901
Dockery GL. The treatment of intermetatarsal neuromas with 4% alcohol sclerosing injections. J Foot Ankle Surg. 1999;38(6):403-408. doi:10.1016/S1067-2516(99)80040-7. PubMed 10614611

Stop putting up with that burning sensation in your foot

If you’ve been stopping halfway through your walk to take off your shoes for months, or if you’ve stopped walking, running, or enjoying a stroll because of the pain— you don’t have to keep living like this. Morton’s neuroma can be effectively treated, and the results are excellent.

San Román Clinic: Over 45 years of caring for your feet. Free consultation.