Morton's Neuroma Treatment London | Private Ultrasound Diagnosis & Injections

Morton's Neuroma Explained

Forefoot & Intermetatarsal Space Anatomy

A Morton’s neuroma is a common forefoot condition that describes a thickening of a small nerve that runs between the toes.

Often, a neuroma is also associated with inflammation of a small fluid-filled sac known as the intermetatarsal bursa.

Symptoms of Morton's Neuroma

Symptoms of a Morton's Neuroma are normally felt as a swelling or patient reported stone or pebble under the affected location in the underside of the forefoot. 

Symptoms may be worse with wearing shoes especially tight fitting footwear which may compress the sides of the foot and therefore reduce the intermetatarsal space and irritate the neural inflammation further. 

Rarely there can be visible swelling through the top of the intermetatarsal space to the top of the forefoot visible.

Causes of Morton's Neuroma

The causes of a Morton's Neuroma involve chronic irritation to the interdigital nerve causing repeated bouts of inflammation and their four over time fibrosis and scarring at the site of the neuroma. 

Causes of the irritation may involve tight or ill-fitting footwear. 

Other causes may involve genetic biomechanical issues which placed excessive load on the forefoot or activities involving significant planter forefoot loading.

Diagnosing Morton's Neuroma

An ultrasound scan can demonstrate the anatomy of the forefoot extremely well under the handling of an experienced sonographer. Depending on the patient’s individual anatomy, the ultrasound probe may be positioned either:

On top of the forefoot (dorsal approach), or on the bottom of the forefoot (plantar approach) the ultrasound can demonstrate:

• Irregularity or effusion of the metatarsophalangeal joints

• The extensor tendons and flexor tendons of the forefoot

When assessing patients for possible Morton’s neuroma, it is important to exclude:

• Pathology of these surrounding structures

• Problems with the plantar plate, which is part of the metatarsophalangeal joint capsule on the underside of the forefoot

• The Morton’s neuroma itself can be visualised at the terminal end of the interdigital nerve, which is the typical anatomical location of the neuroma.

Ultrasound Guided Injections for Morton's Neuroma

How is an Injection Administered for Morton's Neuroma?

An ultrasound-guided injection for Morton’s neuroma can be successfully performed with a non-painful dorsal approach (on top of the foot):

The probe is placed on top of the foot in a longitudinal orientation relative to the foot.

The needle is advanced from the webspace at the end of the probe and is visualised penetrating the intermetatarsal bursa, where the injectate can be seen being delivered.

What to Do After Your Morton's Neuroma Ultrasound Guided Injection

Needle Path & Post-Injection Pain
A Morton's neuroma ultrasound guided injection is guided through the top dorsal aspect of the inter metatarsal space and therefore pain during the injection is minimal. Due to injecting a tight space there may be some post injection pain and in some cases due to the steroid reacting with the inflamed tissue and the subcutaneous tissue there may be a post injection flare in some cases typically lasting two to three days. If this occurs, over-the-counter painkillers (as directed on the patient information leaflet) can be taken.

Wound Care & Infection Risk
Avoid exposing the injection site to dirty or public water (e.g., swimming pools, hot tubs) for 2–3 days to reduce infection risk. Monitor for redness, swelling, or discharge at the injection site and contact me immediately if these occur.

Activity Guidance
Following a Morton's Neuroma injection it is advisable to wear loose fitting shoes and if you have not done so already off the shelf or custom orthotics may be advisable to reduce longer term problems in the forefoot.

Follow-Up
If you experience unusual pain, swelling, redness, or any other concerns following your injection, please contact me immediately.

Other Treatments for Morton's Neuroma

Mobility Exercises for Morton's Neuroma

Strengthening Exercises for Morton's Neuroma 

Morton's Neuroma | Evidence base

Morton’s neuroma is a painful entrapment neuropathy of the common digital nerve, most commonly occurring in the third intermetatarsal space, and presents with forefoot pain, burning, or paraesthesia exacerbated by walking or narrow footwear. Symptoms may fluctuate but often persist without targeted intervention. Evidence supports a conservative management pathway, including footwear modification, metatarsal offloading, and activity modification. Ultrasound-guided injection is a well-supported non-surgical option for patients with persistent symptoms. Corticosteroid injection has moderate to strong evidence for short- to medium-term pain relief, particularly when delivered accurately around the neuroma. Ultrasound guidance improves diagnostic confidence and injection accuracy, allows precise localisation of the neuroma, and reduces the risk of intravascular or intraneural injection. Studies suggest US-guided injections may provide better symptom relief and patient satisfaction compared with landmark techniques, especially in cases with small or deep lesions. Repeat injections should be used cautiously due to diminishing benefit and potential nerve irritation. Surgical excision or decompression is reserved for refractory cases. Overall, ultrasound-guided injection is an effective, low-risk intervention for symptom control in Morton’s neuroma and can delay or avoid the need for surgery in selected patients.

Questions about your forefoot pain?