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Morton neuroma

Essential points for quick revision.

2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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A hot, ischaemic or traumatically swollen forefoot is not a neuroma

Fever, ulceration, rapidly spreading erythema, severe rest pain, blue or cool toes, acute inability to bear weight or focal swelling after a load increase suggests infection, ischaemia, fracture or inflammatory joint disease rather than chronic interdigital nerve irritation.

Action: Assess observations, skin, perfusion, sensation and bony tenderness, obtain urgent radiographs and diabetic-foot or vascular input when indicated, and do not inject the web space until infection, tissue threat and fracture have been excluded.

Synopsis

Localise interdigital nerve pain in the forefoot, distinguish it from metatarsophalangeal, stress and proximal nerve disease, use imaging only when it resolves uncertainty, and progress footwear, metatarsal support, injection and surgery realistically.

  • Morton neuroma causes burning or electric plantar forefoot pain radiating into adjacent toes, often described as a pebble in the shoe and relieved by removing tight footwear or massaging the foot.
  • The third web space is most commonly affected; local web-space tenderness and symptom reproduction with forefoot squeeze or a Mulder click support the diagnosis.
  • First-line investigation is a careful clinical examination including metatarsophalangeal joints, plantar plates, bony stress sites, sensation, pulses and footwear.

Key red flags

An ulcer, spreading warmth, fever or immune compromise requires urgent forefoot infection assessment and pressure offloading.

Investigation priorities

01
First-line clinical forefoot examinationFirst stepFirst line

Localise web-space neural pain and distinguish joint, plantar plate, bony, bursal and proximal nerve disease.

02
First-line weight-bearing foot radiographs when symptoms persistFirst line

Assess metatarsal alignment, stress fracture signs, Freiberg disease, arthritis and deformity.

Management branches

First-lineLocalise the symptomatic web space

Burning forefoot pain radiates into adjacent toes without infection, vascular threat or acute fracture findings.

  1. Map web-space, joint, plantar-plate and metatarsal tenderness and reproduce the familiar symptom rather than a painless click.
  2. Assess standing deformity, callus, calf length, tarsal tunnel, sensation, pulses and the patient's actual shoes.

Key medicines

Topical diclofenac for associated forefoot painSpread 2–4 g of diclofenac 1.16% gel across intact painful forefoot skin per application, up to three or four applications daily for a short trial within the label maximum.
Ultrasound-guided web-space corticosteroid injectionUnder an aseptic trained local protocol, give one low-volume local anaesthetic and corticosteroid injection into the symptomatic intermetatarsal space, avoiding intraneural and plantar fat-pad placement, then review before any repeat.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom