OUR FLAGSHIP CONDITION
Morton’s neuroma: the full treatment ladder, in one clinic.
Sharp, burning or “pebble in the shoe” pain between the toes — most often the third and fourth. We confirm it on ultrasound, then treat it with the right combination of non-surgical and surgical options, in the order the evidence supports.
What Morton’s neuroma actually is
Morton’s neuroma is a compressed, thickened common plantar digital nerve — most commonly the nerve running between the third and fourth metatarsal heads. Despite the name, it is not a tumour. The nerve becomes entrapped and irritated between the metatarsal heads and the transverse intermetatarsal ligament, leading to localised fibrosis, swelling of the nerve, and characteristic pain.
Typical symptoms:
- Burning, stabbing or electric pain in the ball of the foot
- “Pebble in the shoe” sensation
- Pain radiating into the third and fourth toes, sometimes with numbness
- Worse in narrow or high-heeled shoes, relieved by removing footwear and massaging the forefoot
Risk factors: Repetitive forefoot loading, narrow footwear, forefoot deformity (bunions, hammertoes), high-impact sport.
Diagnosis starts with imaging — not guesswork
Forefoot pain between the toes isn’t always Morton’s neuroma. It can mimic, or coexist with, capsulitis, stress fracture, bursitis, plantar plate injury or a range of other nerve entrapments. That’s why every new patient has diagnostic ultrasound at their first consult, performed by James Ferrie.
On ultrasound we look for:
- A hypoechoic mass in the intermetatarsal space, typically > 5 mm in anteroposterior diameter
- Dynamic compression (Mulder’s click visualised in real time)
- Adjacent intermetatarsal bursitis
- Abnormal nerve anatomy explaining the specific symptom pattern
You will see your own ultrasound image during the appointment. We’ll explain what we’re seeing and what it means for your treatment options.
How we treat Morton’s neuroma
Every patient who comes to us for Morton’s neuroma follows the same workup — diagnostic ultrasound and a diagnostic nerve block. The treatment that follows is chosen with you, not for you. Our role is to listen to what you want to get back to, understand how your condition fits into your life and work, and combine that with the clinical findings from your assessment and ultrasound — so we can give you tailored information on which of the three options would suit you best.
Step 1 — Diagnostic ultrasound, reported by a radiologist
We image the affected forefoot in clinic and the scan is formally reported by a radiologist. This confirms the neuroma, measures it, and rules out the common differentials (intermetatarsal bursitis, plantar plate tear, MTP joint capsulitis). You see the images as we do — we name what we find before we talk about treatment.
Step 2 — Ultrasound-guided diagnostic block
A small volume of local anaesthetic placed accurately around the suspect nerve under ultrasound. If your pain settles for the duration of the anaesthetic, we have confirmed the source. This is the gate every patient passes through before any therapeutic intervention — it’s how we make sure the treatment that follows is targeted, not a guess.
How we decide, together.
Once your neuroma is confirmed and the diagnostic block has told us where the pain is coming from, we sit down with the findings and talk through what they mean for you. Which of the three treatment options fits best isn’t a formula — it’s a conversation that draws on three things, weighted equally:
Your goals
What you want to get back to — running, standing at work, a hike booked in three months, dancing at a wedding, being able to walk pain-free around the house — and how soon.
Your lifestyle
Work demands, family commitments, how much time off your feet you can realistically take, what you’ve already tried, and how you feel about injections versus surgery.
Your clinical findings
What we see on ultrasound — neuroma size, nerve adherence, other structures involved — along with chronicity and how your pain responded to the diagnostic block.
With those three inputs on the table, we give you tailored information on which of the three treatment options would be most appropriate — the likely timeline, what each involves, what recovery looks like for someone in your situation, and the trade-offs. You leave with a plan you helped shape, not a plan handed to you.
The three treatment options
Option 1
Injection therapy
The most common first-line therapeutic step for Morton’s neuroma at our clinic — and a good fit for most patients. Two ultrasound-guided options, chosen together:
- Hydrodissection — fluid is used under ultrasound to separate the nerve from the tissue it has adhered to, addressing the mechanical cause.
- Long-acting botulinum toxin — an image-guided injection that can give 3–6 months of pain relief by modulating the signalling of the affected nerve. A longer-acting alternative to cortisone, without the tissue-thinning effects.
In-clinic. No hospital. Recovery in days.
Option 2
Cryoneurolysis
An image-guided treatment for patients wanting longer-term relief from nerve pain. A small cold probe, placed under ultrasound, interrupts the pain-carrying fibres of the neuroma — without cutting, without hospital admission, and without the structural changes of surgery.
Often chosen by patients whose pain has returned after injection therapy, or who want durable symptom control without the recovery of a surgical approach.
In-clinic. Recovery measured in days.
Option 3
Surgery
Where surgical management is indicated — based on anatomy, neuroma size, response to the diagnostic block, and the patient’s circumstances — we refer directly to our specialist podiatric surgeons: A/Prof Mark Gilheany and Dr Tristan Fairbairn, both registered specialists in reconstructive foot and ankle surgery.
Surgery is considered where it is the right fit for you — not as a failure of the other options, and not as a default.
Individual results vary. Which option fits — and when — depends on your imaging, your response to the diagnostic block, your symptoms, your goals and your lifestyle. Every option is discussed with you, and the decision is made together.
A plan, not a pamphlet
After your diagnostic ultrasound, we map your presentation against four factors: duration of symptoms, size and location of the neuroma on ultrasound, what you have already tried, and your goals and constraints. You leave with a written plan: the first modality we are trying, why, what the likely timeline looks like, and what the next step is if the first doesn’t work.
Common questions
Is cortisone injection a good treatment for Morton’s neuroma?
Cortisone can provide short-term relief but repeated injections are not recommended. The evidence base supports graded conservative care first, then hydrodissection or cryoneurolysis before surgery.
How is cryoneurolysis different from surgical excision (neurectomy)?
Cryoneurolysis preserves the outer nerve sheath (epineurium), which reduces the risk of stump neuroma — a known complication after surgical excision. It’s also percutaneous (no incision), performed under local anaesthetic, and you walk out the same day.
Can I have the ultrasound, diagnosis and treatment at the same visit?
Diagnosis almost always, yes. Treatment depends on what we find. Orthotic casting, shockwave, PBM and some hydrodissection can be started at the first visit. Cryoneurolysis and surgery are scheduled separately.
How long until I can run again?
It depends on the option we choose and how your symptoms respond. Typical ranges reported in the literature and in clinical practice: 4–8 weeks from starting conservative care; 2–3 weeks after cryoneurolysis; 8–12 weeks after surgery. Individual results vary.
What if I’ve already had surgery and the pain came back?
Recurrent or stump neuroma pain after surgical excision is unfortunately well described. We review the operative history, image the site, and assess whether revision surgery, cryoneurolysis or regenerative care is the best option for you.