Morton's Neuroma

In summary: many Morton’s neuromas improve with insoles and ultrasound-guided injections, without surgery. We confirm and measure it with ultrasound during the same consultation and, if necessary, guide the injection to the exact point.

Morton’s neuroma is a thickening of the tissue around a nerve in the forefoot, usually between the third and fourth toes. The nerve becomes compressed and causes burning, tingling, or a sensation of electric shock.

A typical sign: feeling like there is a fold in your sock when there isn’t one, and relief when taking off your shoe. We confirm it with ultrasound and choose the appropriate treatment.

The “pebble” in the sock and cramps in the toes: why they happen

Morton’s neuroma has very characteristic symptoms, but at the same time they are easy to confuse with other forefoot problems.

The most typical: the sensation of stepping on a pebble or wearing a wrinkled sock, when there is nothing there. Also cramps or tingling that go down towards the toes, and that need to take off your shoe and massage your foot that those who suffer from it know very well.

This happens because a compressed nerve does not hurt like a muscle or a bone: it sends “electrical” sensations —burning, cramps, numbness— that come and go depending on footwear and activity. With narrow shoes, it gets worse; barefoot, it usually gives relief. In early stages, symptoms may appear only with specific footwear or after walking for a long time; over time, they tend to become more constant.

Neuroma or metatarsalgia: how to tell them apart

The forefoot is small and the causes of pain are mixed there. Metatarsalgia causes pain due to overload of the bones and tissues; the neuroma, due to compression of a nerve. They can look very similar —and sometimes coexist.

Distinguishing them matters because the treatment changes. In the consultation we do this with two tools:

• Specific examination: maneuvers that reproduce the nerve symptoms.
• Ultrasound the same day: we confirm the neuroma, measure it, and rule out other causes.

If confirmed, the same ultrasound machine serves to guide the treatment: ultrasound-guided injections allow us to reach the exact point, not just “nearby”.

What you can do while waiting for your visit

Without a diagnosis there is no serious treatment, but there are some gestures that usually give relief:

• Choose shoes with a wide toe box and avoid those that squeeze the toes together.
• Reduce high heels: they shift the load precisely towards the nerve area.
• If a specific footwear triggers the symptoms, stop wearing it for a while.

What we do not recommend is living with it for months. The longer the nerve is irritated, the less margin conservative options tend to have. Custom insoles, designed after studying your gait to open up space for the nerve, are often the first step of treatment —and they work better when the problem has not become chronic.

If you are in doubt about making an appointment or waiting, a simple reference: when the discomfort makes you change footwear or avoid things you used to do normally, it is already a reason for a visit. The assessment is done with ultrasound included, in Martorell, Barcelona (Teknon) or Igualada.