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1 · SNAPSHOT

Morton's Neuroma (Interdigital Nerve Entrapment) body chart — Illustrative, not diagnostic. Canva body chart for Morton's Neuroma (Interdigital Nerve Entrapment).

Who: Narrow shoes, high heels, and forefoot compression. Commonly the third-fourth webspace.
What: Entrapment and perineural fibrosis of an interdigital nerve. Not a true tumour, despite the name.
How it behaves: Sharp, burning pain or numbness between the toes. "Bunched-up sock." "Stone in the shoe." Worse with tight shoes and forefoot compression. Eased by taking the shoe off and rubbing the foot.

The one thing to take from this page:

The first treatment is mechanical decompression. An injection into a foot that is still wearing the shoe that caused it treats the pain and leaves the cause in place [7][10].

Fits neuroma	Fits mechanical metatarsalgia
Radiates into the toes	Stays under the metatarsal heads
Numbness or tingling	Normal sensation
Webspace tenderness	Tenderness under the heads, with callus
Dramatic relief taking the shoe off	Eased by rest and cushioning

⚠️ One thing you may have been taught that we can't support

"A neuroma over 10 mm on imaging often needs surgical excision." That threshold is commonly taught and no source in our library verifies it. Size may inform a surgeon's thinking; it is not your referral trigger, and it is not a rule on this page. Saying "I don't know the number" is better than quoting one you can't stand behind.

⚠️ No guideline exists, anywhere. Anchored to the Cochrane review [1], whose own finding is that the treatment evidence remains limited and heterogeneous.

2 · SE — THE SUBJECTIVE PATTERN (the 70%)

Five stages, in your course's order. The patient's own metaphor is often the diagnosis.

MAIN PROBLEM

"It's like there's a stone in my shoe and I can't get it out."
"My sock feels bunched up under my toes."
"Two of my toes have gone numb."

BODY CHART

Mark the webspace, not the metatarsal head. Which one? Third-fourth is classic; second-third happens.
Draw the radiation into the adjacent toes. If it doesn't radiate, reconsider.
Mark numb areas separately from painful ones.

BEHAVIOUR

	Fits neuroma	Points elsewhere
Aggs	Tight shoes, high heels, forefoot compression, walking in shoes	Load and distance regardless of shoe → metatarsalgia
Eases	Taking the shoe off, massaging the foot — often dramatic	Rest, cushioning → metatarsalgia
Severity	VAS 0–10 at best / at worst / right now	—
Quality	Sharp, burning, electric	Ache, burning under the heads
Sensory	Numbness, tingling into the toes	Normal

HISTORY

Footwear. In detail — width, heel height, what they wear to work, what they wear to exercise. This is the exposure.
Onset and progression.
What has already been tried, particularly injections — and whether the footwear was changed at the same time. Usually it wasn't.

SPECIAL / SCREENING QUESTIONS

Focal bony tenderness, load spike — the stress fracture screen.
Toe drift, swelling, instability — the plantar plate question.
Bilateral or stocking-distribution numbness, back symptoms — systemic or lumbar. Screen the chain.

Assessing this region? Download the Ankle & Foot assessment template →

3 · HYPOTHESIS RANKING

Competing pattern	The one discriminating feature
Metatarsalgia	Aching under the metatarsal heads with callus, no radiation into the toes and no sensory change.
Metatarsal stress fracture	Focal bony tenderness with pain on percussion or hop; load-history driven.
Freiberg's disease	Dorsal metatarsal head tenderness with reduced MTP range, rather than webspace compression pain.

The one that changes what you should do next

Intermetatarsal bursitis. It sits in the same webspace, produces the same symptoms, and should be considered before anyone injects or refers for neuroma surgery [2][3]. Imaging and the symptom pattern together help avoid the misclassification.

And the plantar plate, which produces forefoot pain with toe instability and drift rather than neural symptoms.

4 · RED FLAGS — DON'T MISS THIS

This section is free, on every pattern, forever. Safety is never gated.

Finding	What it suggests	What you do
Focal bony tenderness + load spike, pain on hop	Metatarsal stress fracture	Offload and image
Night or rest pain not relieved by removing footwear	Not this pattern	Medical referral
Bilateral numbness, stocking distribution	Peripheral neuropathy	Medical referral
Morton's-type pain with any features of inflammatory arthritis	Inflammatory arthritis — in one series 40% of people presenting with Morton's metatarsalgia had or went on to develop rheumatoid arthritis (Awerbuch et al. 1982) [22]	Medical referral for an inflammatory screen
Back or proximal symptoms with the foot numbness	Lumbar or double crush	Screen the chain
Progressive motor loss, wasting, clawing	Beyond an interdigital nerve	Medical referral
Diabetic foot with numbness and a pressure lesion	Neuropathic ulcer risk	🚑 See the infection page
A rapidly enlarging or firm mass — or any forefoot lump with rest pain and focal swelling	Not a neuroma. Foot sarcomas most often sit in the forefoot, and rest pain and focal swelling were the commonest complaints (Jenkins et al. 2025) [21]	Imaging, medical referral. Biopsy only after discussion with an oncology surgeon

The rule: webspace pain that changes with footwear is yours. Bony, systemic, bilateral, progressive or motor is not.

Cross-links: Metatarsalgia · Tarsal tunnel syndrome · Peripheral nerve entrapments

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Twelve slides on this pattern: what you'll hear, what to examine, what to do. Free with an account.

Guideline anchor

No guideline exists for Morton's neuroma, in Australia or anywhere.

Anchored to the Cochrane review of interventions (Matthews et al. 2024, PMID 38334217), which is the highest-level synthesis available, supplemented by the current concepts review (Bhatia & Thomson 2020, PMID 32405199) and the diagnostic accuracy systematic review (Pitcher et al. 2024, PMID 39564390).

PubMed Source

The Cochrane review is a synthesis of treatment evidence, not a guideline, and its finding is that the evidence remains limited and heterogeneous. There is no consensus pathway and no physiotherapy-specific guidance anywhere. The staged approach on this page — decompress mechanically, then escalate — comes from the reviews and is labelled as such.

Members

The evidence summary is for members

Verified diagnostic accuracy, where the evidence stands and what it doesn't settle. Free with an account.

Sources · 20

Show

Every source on this page resolves and title-verifies against PubMed. Newest first.

2024Matthews et al. (2024). Treatments for Morton's neuroma. The Cochrane database of systematic reviews, 2(2), CD014687. https://doi.org/10.1002/14651858.CD014687.pub2
2023Larsen et al. (2023). Diagnostic Considerations of Intermetatarsal Bursitis: A Systematic Review. Diagnostics (Basel, Switzerland), 13(2). https://doi.org/10.3390/diagnostics13020211
2025Larsen et al. (2025). Morton's Neuroma or Intermetatarsal Bursitis-A Prospective Diagnostic Study of Intermetatarsal Pain. Diagnostics (Basel, Switzerland), 15(11). https://doi.org/10.3390/diagnostics15111339
2015Bignotti et al. (2015). Ultrasound versus magnetic resonance imaging for Morton neuroma: systematic review and meta-analysis. European radiology, 25(8), 2254-62. https://doi.org/10.1007/s00330-015-3633-3
2018Santiago et al. (2018). Role of imaging methods in diagnosis and treatment of Morton's neuroma. World journal of radiology, 10(9), 91-99. https://doi.org/10.4329/wjr.v10.i9.91
2019Gougoulias et al. (2019). Morton's interdigital neuroma: instructional review. EFORT open reviews, 4(1), 14-24. https://doi.org/10.1302/2058-5241.4.180025
2019Matthews et al. (2019). The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Morton's neuroma): a systematic review and meta-analysis. Journal of foot and ankle research, 12, 12. https://doi.org/10.1186/s13047-019-0320-7
2020Bhatia & Thomson (2020). Morton's neuroma - Current concepts review. Journal of clinical orthopaedics and trauma, 11(3), 406-409. https://doi.org/10.1016/j.jcot.2020.03.024
2020Colò et al. (2020). The effectiveness of shoe modifications and orthotics in the conservative treatment of Civinini-Morton syndrome: state of art. Acta bio-medica : Atenei Parmensis, 91(4-S), 60-68. https://doi.org/10.23750/abm.v91i4-S.9713
2021Choi et al. (2021). Corticosteroid Injection for Morton's Interdigital Neuroma: A Systematic Review. Clinics in orthopedic surgery, 13(2), 266-277. https://doi.org/10.4055/cios20256
2021Klontzas et al. (2021). Ultrasound-guided treatment of Morton's neuroma. Journal of ultrasonography, 21(85), e134-e138. https://doi.org/10.15557/JoU.2021.0022
2022Koti et al. (2022). Long-term results of dorsal neuroma/nerve transposition in the surgical management of Morton's neuroma and correlation with intraoperative anatomical variations. Journal of orthopaedic surgery and research, 17(1), 22. https://doi.org/10.1186/s13018-022-02910-2
2022Lorenzon et al. (2022). Infiltrative Therapy of Morton's Neuroma. Acta bio-medica : Atenei Parmensis, 92(S3), e2021556. https://doi.org/10.23750/abm.v92iS3.12545
2022Xu et al. (2022). Plantar and dorsal approaches for excision of morton's neuroma: a comparison study. BMC musculoskeletal disorders, 23(1), 898. https://doi.org/10.1186/s12891-022-05858-w
2023Zhang et al. (2023). Effect of surgical approach on the treatment of Morton's neuroma: a systematic review and meta-analysis. Journal of foot and ankle research, 16(1), 57. https://doi.org/10.1186/s13047-023-00660-w
2024Fenech (2024). Sonographic anatomy and technique to image the plantar digital nerves and aid identification of a Morton's neuroma. Ultrasound (Leeds, England), 32(2), 114-126. https://doi.org/10.1177/1742271X231215716
2024Lee et al. (2024). The comparison of postoperative outcomes in Morton's neuroma excision between plantar versus dorsal approach: A systematic review and meta-analysis. Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons, 30(8), 621-629. https://doi.org/10.1016/j.fas.2024.05.018
2024Millán-Silva et al. (2024). Infiltrative Treatment of Morton's Neuroma: A Systematic Review. Pain management nursing : official journal of the American Society of Pain Management Nurses, 25(6), 628-637. https://doi.org/10.1016/j.pmn.2024.06.005
2024Pitcher et al. (2024). Diagnostic Accuracy of Subjective Features and Physical Examination Tests for Morton Neuroma: A Systematic Review. Foot & ankle orthopaedics, 9(4), 24730114241291055. https://doi.org/10.1177/24730114241291055
2025Llombart-Blanco et al. (2025). Systematic Review and Meta-analysis of Radiofrequency Ablation for Morton's Neuroma: Outcomes and Predictors of Success. American journal of physical medicine & rehabilitation, 104(5), 465-472. https://doi.org/10.1097/PHM.0000000000002668

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Foot Health Status Questionnaire
foot health and general health · 6 min

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