Can Morton’s neuroma go away on its own? And does surgery work?

You feel a pebble under the ball of your foot that isn’t there. Burning shoots into your third and fourth toes. You take off your shoe, rub your foot, and it eases. So you wonder: if I just give it time, will Morton’s neuroma go away on its own?

Here is the honest answer, what the first steps can and can’t do, and what Morton’s neuroma surgery has achieved for people followed for years.

Can Morton’s neuroma go away on its own?

The pain can come and go. The thickened nerve usually stays.

Morton’s neuroma isn’t a true tumor. It is scar-like thickening around a small nerve between two toes, most often the third and fourth.^[1,2] Doctors call this perineural fibrosis, meaning scar tissue wrapped around the nerve. Roomy shoes and pads can take pressure off that tissue, but they don’t remove it.

A neuroma doesn’t always hurt. In one study of foot MRI scans, a third of people with no neuroma symptoms had one.^[6] That explains why the first steps sometimes work: if you take enough pressure off the nerve, it can go quiet. It also explains why the pain often comes back when pressure returns.

Can Morton’s neuroma be fixed for good?

For many people, yes. The American Academy of Orthopaedic Surgeons says surgery is often considered the most reliable treatment, with many studies showing long-term success rates of 80% to 95%. By comparison, shoe changes, orthotics and activity changes give some relief to up to about half of people. Steroid injections give short-term relief to about 50% to 70%, and long-term relief is less common.^[2]

A systematic review of 29 studies found better outcomes with operative treatment than with other care.^[7] A pooled analysis of 35 studies and nearly 3,000 people found complete pain relief in 74% after neurectomy and 68% after nerve release, compared with 43% after injection. Complication rates were similar.^[8]

Does neuroma surgery work in the long run?

Yes. Long-term studies show results that hold up for years.

• About 15 years later. In 98 feet followed for an average of 15.3 years after neuroma removal, 76.5% had an excellent or good result.^[3]
• About 7 years later. In 160 people followed for a median of 7.1 years after removal through the sole of the foot, 89.4% reported a good result.^[9]
• Five to 12 years later. In 41 people, average pain fell from 7 to 1.4 out of 10, and 91% had good or very good results. The results didn’t fade over the years of follow-up.^[10]
• Within a staged plan. In 115 people treated step by step, 85% improved overall. The 21% who went on to surgery had a satisfactory result 96% of the time.^[11]

There are two main operations. Neurectomy removes the thickened part of the nerve. Decompression releases the ligament pressing on the nerve and leaves it in place.^[2] Dr. Efe Ozturk, a double board certified Foot and Ankle Surgeon and podiatrist, explains both on our Morton’s neuroma surgery page.

What can shoes, pads and injections do?

Start here. These steps help many people, and they are how we confirm the diagnosis and buy time. See Morton’s neuroma for the full picture.

• Shoes and orthotics. In a randomized trial, 63% of people treated with footwear changes had complete or partial relief at one year.^[12] A review found that after about four and a half months, and for neuromas larger than 5 to 6 mm, shoes and orthotics worked more as a way to live with the pain than as a real treatment.^[4]
• Steroid injections. In 39 people given one ultrasound-guided injection, pain eased at six weeks. By one year, scores had nearly returned to where they started. The benefit lasted longer in neuromas 5 mm or smaller.^[5]
• Size and injections. In 136 people, neuroma size on ultrasound was the only factor that predicted an injection would fail, and 15% went on to surgery.^[13]

If you have changed your shoes, used a pad and had an injection, and the pain keeps coming back, more time isn’t likely to change the answer. That is the point to talk with a surgeon. Our parent practice explains other causes of ball of foot pain (external site).

What helps neuroma surgery succeed?

• Earlier surgery. Results were strongest with single neuromas larger than 3 mm removed within 12 months of the first symptoms.^[10]
• One neuroma, not several. Feet with one neuroma did better than feet with neuromas in more than one space.^[3,10]
• A clear diagnosis. Because neuromas can show up on scans without causing pain, your symptoms and exam matter as much as the picture.^[6]

How long does it take to recover from neuroma surgery?

The recovery is short compared with many foot operations. You usually walk in a stiff-soled post-op shoe. You avoid running, jumping and soaking the foot until the wound has healed, usually at least two to three weeks. Most people are back in normal shoes by about four weeks.^[2] Protocols differ, so you follow your surgeon’s plan. Our Center for Lower Extremity Surgery explains recovery after foot and ankle surgery (external site).

What about radiofrequency ablation?

Radiofrequency ablation uses heat from a needle to quiet the nerve. In a study comparing it with removal, both lowered pain, but removal lowered it more. A quarter of people who had ablation later needed removal anyway, and a third had a repeat ablation.^[14]

What are the limits?

Surgery doesn’t work for everyone. In one study, 79% of people rated their result as excellent or good, but only 63% were completely pain-free.^[15] After neurectomy, numbness between the two toes is common and often permanent, and a painful nerve end, called a stump neuroma, can form.^[2,3] In the comparison above, complications were more common after removal than after ablation (13% vs 3.7%).^[14] Studies don’t agree on whether neuroma size predicts the result of surgery.^[16] Most surgical studies are case series rather than randomized trials.^[7]

Common questions

Can Morton’s neuroma go away without surgery?

The pain can settle with roomy shoes, pads and sometimes an injection, especially when the neuroma is small and caught early.^[5,4] If it keeps coming back, surgery is often considered the most reliable next step.^[2]

What is Morton’s neuroma surgery?

It either removes the thickened nerve (neurectomy) or frees it by releasing the tight ligament above it (decompression).^[2]

What if symptoms come back after surgery?

About 5% to 20% of people have symptoms return. A repeat operation has a success rate similar to the first.^[2] See revision nerve surgery.

When to see a specialist

See us if ball-of-foot pain or burning toes last more than a few weeks despite roomy shoes, or if an injection wore off. We see patients in Lyndhurst, Paramus and Millburn. Please call our office at 908-215-5953 to inquire about your insurance.