By Jeff Stewart – Podiatrist (B.Pod La Trobe, M.A.Pod.A NSW) | Manly Cove Podiatry
Morton’s neuroma is one of the more frustrating conditions I see at Manly Cove Podiatry. Patients usually describe it the same way: a burning or tingling pain between the third and fourth toes, often with a strange sensation that there’s a pebble or a fold in their sock, no matter how many times they shake their shoe out.
It’s a thickening of the tissue around one of the nerves running between the toe bones, usually caused by repeated compression. Once that nerve is irritated enough, ordinary walking, let alone a run along the Manly to Spit track or a game of tennis, can be enough to set it off.
What Causes Morton’s Neuroma?
It’s rarely one thing on its own. In clinic, I usually see a combination of:
Past injury. An old forefoot injury can leave the nerve more sensitive than it should be.
Footwear. Narrow toe boxes and high heels squeeze the forefoot and compress the nerve, which is why it’s so common in patients who spend a lot of time in dress shoes or heels around Manly and the CBD.
Foot shape and mechanics. High arches, flat feet, bunions and hammertoes all change how load moves through the forefoot, putting more pressure on that nerve.
High-impact activity. Running, tennis and court sports load the ball of the foot repeatedly, which can aggravate or bring on a neuroma.
Standing for long periods. Especially in unsupportive shoes, this is a common one for hospitality and retail workers on the Northern Beaches.
How It Progresses
It usually starts small: an occasional burning sensation or tingling in the ball of the foot after a long walk or a run, gone by the next morning. Left alone, it tends to build. The tingling can turn into numbness, the burning pain more frequent, and eventually it can flare up in ordinary shoes doing ordinary things, not just during sport or a big day on your feet.
When Should You See a Podiatrist?
It’s worth booking in if:
- The burning, tingling or numbness between your toes has lasted more than a few days
- It’s happening more often, or starting to show up in shoes that never used to bother you
- Pain is changing the way you walk, or you’re avoiding activities because of it
- Over-the-counter pads or wider shoes haven’t made a real difference
The earlier it’s assessed, the more options are on the table. Left untreated, the nerve thickening can become more established and harder to settle with conservative treatment.
How We Diagnose and Treat Morton’s Neuroma
Diagnosis is mostly clinical. I’ll examine the foot, check for the small click (Mulder’s sign) that often confirms a neuroma, and look at how you stand and walk. If needed, we can refer you for a diagnostic ultrasound to confirm the size and exact location, which also helps rule out anything else that can mimic a neuroma.
Treatment almost always starts conservatively:
- Footwear assessment – A wider toe box and lower heel takes pressure off the nerve immediately, often the single biggest thing that helps.
- Padding and offloading – Metatarsal pads redistribute pressure away from the irritated area.
- Custom orthotics – Where biomechanics are driving the problem, orthotics correct the underlying mechanics rather than just padding around the symptom.
- Activity and load adjustments – Short-term changes to high-impact activity while things settle.
When conservative treatment doesn’t resolve things, we’ll refer you on for corticosteroid or alcohol sclerosing injections, or, in persistent cases, a surgical opinion. Surgery is a last resort and not something we perform in-clinic, but it’s rarely needed if the condition is caught and managed early.
Why Sort This Out Sooner Rather Than Later
A neuroma doesn’t tend to improve on its own once it’s established, and the longer that nerve stays irritated, the more the tissue around it thickens. Caught early, most cases settle well with footwear changes, padding and orthotics alone. Left for months, you’re more likely to need injections or a surgical opinion to get the same result. There’s no upside to waiting it out.
At Manly Cove Podiatry, we treat Morton’s neuroma in patients across Manly, Freshwater, Dee Why, Balgowlah, Seaforth, and the wider Northern Beaches. Whether you’re a runner whose forefoot pain only shows up mid-session, or you’ve been living with that burning, tingling feeling between your toes for months, a proper assessment gives you a clear diagnosis, a clear treatment plan, and a realistic path to relief.
Book a Morton’s Neuroma assessment at Manly Cove Podiatry
Phone: (02) 8966 9552
Address: Suite 12, 35-36 East Esplanade, Manly NSW 2095
Hours: Monday to Friday 8am-6pm, Saturday 8am-12pm
Saturday appointments available – no referral needed
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