Morton’s Neuroma: Physical Therapy, Exercises, Recovery Time?

Do you have Morton’s neuroma, or a doubt about the diagnosis of your foot pain?

Would you like to understand what it is, what causes it, and what treatments are available, with or without physiotherapy?

I take stock, based on published studies as well as my own experience.

♻️ Last update: January 14, 2025.
👩‍⚖️ Declaration of financial interests: Amazon affiliate link. My complete declaration of financial interests is in legal mentions.
Written by Nelly Darbois, physiotherapist and scientific editor

What happens in the body when you have Morton’s neuroma?

The nerves that make up our body can be damaged in many different ways.

When you have a neuroma, it means that there is a mass or abnormal thickening of one or more nerves in your body.

Morton’s neuroma is a particular type of neuroma located in the foot. More precisely, it affects the nerve known as the “plantar interdigital”, which runs between the 3rd and 4th metatarsal bones in the extension of your toes.

The nerve becomes thicker at this point, causing pain.

The name comes from Thomas G. Morton, a 19ᵉ century American physician, who first described the condition.

How can you be sure that your foot pain is really Morton’s syndrome?

Morton’s neuroma is one of the most common causes of forefoot pain.

These criteria increase the likelihood of this being the case:

• neuropathic pain: burning, stabbing, electric shocks, sensory disturbances radiating to the toes (and sometimes to the hindfoot or leg);
• pebble-in-the-shoe” feeling;
• greater pain when walking or wearing heels or narrow shoes;
• pain relieved by resting, removing shoes and massaging the forefoot;
• increased pain when pressure is exerted on the intermetatarsal space with a finger or the edge of a coin, or when the forefoot is compressed to the side at the level of the heads of the metatarsals;
• you are between 40 and 60 years old;
• you are a woman (4 to 5 times more common in women than in men).

In the vast majority of cases, a clinical examination is sufficient to diagnose this syndrome.

Imagery such as X-rays, MRIs or ultrasounds are only used to rule out other causes, if your doctor has any doubts: fatigue fracture of the metatarsal, alcoholic neuropathy, etc.

Your doctor or physiotherapist may also perform the Mulder test:

• he grasps the supposed neuroma between the thumb and index finger of one hand: the thumb is on the plantar surface;
• with the other hand, he applies lateral pressure to the forefoot at the level of the heads of the metatarsals.

The test is considered positive when the examiner feels or hears a “click”.

A positive test confirms the presence of the neuroma.

But if it’s negative, it still doesn’t rule out the possibility that you do indeed have a neuroma.

Can cancer be confused with Morton’s neuroma?

When you’re in a lot of pain somewhere, you’re often afraid of missing a cancer, a benign or malignant tumor.

Yet Morton’s neuroma is a well-known condition that has nothing to do with cancer.

It’s very unlikely that you’ll get cancer from forefoot pain. It’s much more likely to be Morton’s neuroma.

What causes this neuroma?

Morton’s neuroma is thought to be caused by the following:

• repeated micro-trauma to this nerve;
• compression of the nerve in the metatarsal canal;
• compression by bursitis ;
• lack of blood supply to the nerve (ischemia).

And these situations are more likely to occur when :

• you often wear narrow shoes;
• you often wear high heels;
• you practice running, dancing or other sports with high impact on the feet.

What is the recovery time for this syndrome?

There are no studies tracking the evolution of people diagnosed with this neuroma and comparing the evolution of those who undergo treatment versus those who do not.

So we don’t really know how Morton’s neuroma evolves without treatment, and whether and how long it takes to resolve on its own.

Pain is a complex phenomenon, often linked to many different causes: it is therefore reasonable to assume that the pain associated with this neuroma will last from a few days at best, to several weeks or even months.

What are the different types of treatment for Morton’s neuroma?

Here are the different treatments described to relieve foot pain in Morton’s neuroma and try to reduce irritation or thickening of the nerve.

Modification of footwear and physical activity

The first possible course of treatment is toadapt your footwear:

• avoid heels;
• choose shoes with the widest possible forefoot;
• keep your shoes off at home.

If you feel that your pain is getting worse during or after certain sports, consider how you can adapt the dosage of this activity to gradually increase the frequency, intensity or duration of your sessions.

Some people are relieved by the addition of plantar pads placed under the heads of the metatarsals to widen the intermetatarsal space (see on Amazon), or plantar orthoses (aka orthopedic insoles), either custom-made by a podiatrist, or bought in series (= not custom-made).

Medication?

There are no studies comparing the evolution of people with Morton’s neuroma who take this or that type of medication, versus those who don’t or take a placebo.

Medications that are sometimes prescribed or offered are :

• mainly non-steroidal anti-inflammatory drugs (NSAIDs);
• more anecdotally, amitriptyline (an antidepressant).

Exercise, physiotherapy and manual therapy

Physical therapy is often prescribed for Morton’s neuroma. The type of treatment offered depends on your physiotherapist’s assessment, as well as his or her habits and your personal preferences:

• support in adapting the amount and type of physical activity, lifestyle, footwear, pain management (+++ what I prefer ++);
• massage, shock waves, manual therapy, ultrasound, TENS: techniques designed to relieve pain in the moment. (Two published clinical trials have shown no effect of shock waves in this indication).
• stretching, muscle-strengthening and foot-mobilization exercises. Specific exercises have not been evaluated in clinical studies.

Corticosteroid infiltration

If adapting footwear and the amount of physical activity is not enough, academic publications suggest corticosteroid infiltration of the foot.

A few clinical trials have sought to objectivize the effect of infiltrations, sometimes without a control group.

After 3 to 12 months’ follow-up, 3 to 5 out of 10 people who received infiltration were totally satisfied with its effect (except in one study, where only 6 out of 100 patients were totally satisfied).

The effect is generally felt 1 week after infiltration.

3 out of 10 patients still required surgery to treat the neuroma despite infiltration, in the studies that observed this parameter.

Ultrasound-guided infiltration (compared with no ultrasound) appeared more effective for pain relief at 6 months.

Adverse events reported in the trials were rare:

• atrophy of the plantar fat pad = less fat on the foot at the injection site;
• skin depigmentation = your skin becomes lighter at the injection site;
• joint capsule ruptures = some of the tissues surrounding your joint are a little damaged.

Alcohol infiltration

Instead of corticosteroid injections, alcohol infiltrations are sometimes suggested. This is less common.

The effect of alcohol infiltration on Morton’s neuroma has been evaluated in over 800 patients.

According to these studies, long-term relief was achieved in 3 out of 10 patients.

Surgery was finally performed within 12 months of alcohol infiltration in 1 to 3 out of 10 patients.

But severe pain following infiltration, sometimes lasting up to 3 weeks, was observed in 2 out of 10 patients.

Other non-surgical treatments

Other non-surgical treatments are sometimes proposed, but very few have been evaluated:

• capsaicin infiltration;
• botulinum toxin injection ;
• nerve destruction by radiofrequency, cryotherapy or laser.

Laser treatment

A 1992 study described the use of the CO2 laser to treat Morton’s neuroma (Wasserman 1992). The authors reported that this method was effective, with a reduction in postoperative pain and healing time compared to conventional surgery.

However, this study is old, has never been replicated, and lacks methodological rigor.

A more recent systematic review of non-surgical treatments for Morton’s neuroma did not identify laser treatment as a therapeutic option (Thomson 2020).

Operation in case of failure

If all non-surgical treatments have failed and you insist on trying another, surgery may sometimes be proposed.

Depending on the surgical team you choose, different techniques are offered:

• neurectomy: the damaged part of your nerve is removed;
• neurolysis: your nerve is decompressed by cutting a ligament.

There are few trials evaluating the effect of these techniques.

6 out of 10 patients describe themselves as totally satisfied after these operations for Morton’s neuroma, but almost 1 out of 10 who have already undergone surgery once require a new operation.

The side effects and complications described (but not systematically) are :

• wound infection,
• painful scar,
• chronic pain,
• stiffness of the metatarsophalangeal joint,
• sensitivity disorders with toe anesthesia and ant sensations have been reported (especially after neurectomy).

Rehabilitation sessionsafter surgery for Morton’s neuroma are often prescribed.

During the convalescence period of a few days to a few weeks, walking with support on the foot is generally permitted.

The idea is to gradually resume all your physical activities, adapting them according to how you feel.

Power supply

There is no scientific evidence that a specific diet can prevent or treat Morton’s neuroma.

Of course, general dietary advice remains valid: eat whole, nutrient-rich foods, with good hydration, and limit excess sugar, salt and saturated fats.

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That’s all I wanted to say on the subject! Any questions or comments? See you in comments!