Morton's neuroma is a thickening of the nerve tissue between the metatarsal heads — most commonly in the third interspace, between the third and fourth toes. The nerve responds to chronic compression and irritation by developing a fibrous thickening. The result: burning, shooting, or aching pain in the ball of the foot, often with a sensation of "walking on a pebble." Symptoms are typically worse in narrow or high-heeled shoes and better barefoot or in wider footwear.
Why it develops
The intermetatarsal space narrows when the forefoot is compressed — by tight shoes, by metatarsal splaying from hypermobile foot mechanics, or by altered gait patterns from proximal dysfunction. When that space is chronically narrow, the nerve that passes through it is chronically compressed. Over time, the nerve thickens as a protective response to that compression. The thickening then perpetuates the compression. It's a self-reinforcing cycle.
The key drivers: metatarsal compression from footwear, hyperpronation and metatarsal splay from poor ankle and midfoot mechanics, and altered toe-off mechanics from upstream restriction in the ankle, calf, or hip. All of these are addressable. Most neuroma treatment skips most of them.
Corticosteroid injections provide temporary relief but don't change the mechanics creating the compression. Surgical neuroma excision has significant downtime and leaves permanent numbness in the affected toes. Conservative care that addresses the biomechanical drivers resolves most Morton's neuroma cases — and should be fully explored before injections or surgery are considered.
What we do
Metatarsal mobilization to restore the normal spread of the metatarsal heads and reduce interspace compression. Active Release Techniques® to release the interosseous muscles and intrinsic foot musculature contributing to forefoot compression. Calf and Achilles work to restore dorsiflexion — limited ankle dorsiflexion is one of the most consistent upstream drivers of altered forefoot loading.
Footwear assessment and modification — often the most immediately useful intervention. A wider toe box, metatarsal pad placement, and in some cases custom orthotics to support the transverse arch and reduce metatarsal splay.
For established neuromas with significant fibrotic thickening, Shockwave Therapy (ESWT) applied to the intermetatarsal space reduces the fibrous mass and improves nerve mobility. Evidence for ESWT in Morton's neuroma has been growing since 2015 and the outcomes compare favorably with injection at six- and twelve-month follow-up.
What to avoid
Narrow shoes and high heels — eliminate them during treatment and reintroduce cautiously. Barefoot on hard surfaces for extended periods loads the metatarsal heads directly and can flare symptoms. High-impact activity on hard surfaces until mechanics are restored. Waiting too long: the longer the nerve is compressed, the more the fibrous thickening establishes itself and the longer correction takes.