Neuroma treatment: non-surgical and surgical options

Two kinds of neuroma

The word “neuroma” is used for two different problems:

• Morton’s neuroma — a thickened, irritated nerve in the ball of the foot, usually between the third and fourth toes, caused mainly by repeated compression.^[4] See Morton’s neuroma.
• A traumatic (or “stump”) neuroma — a tangle of nerve fibres that forms where a nerve was injured or cut, for example after an injury or an operation. Some are painless; others are very sensitive.^[7] See nerve pain after surgery or injury.

The treatments overlap, but the details differ, so this page covers both.

First, confirm the diagnosis

Pain in the ball of the foot or near a scar has several possible causes. Before recommending any treatment beyond simple measures — and always before surgery — the aim is to be confident about which nerve is involved and why. That may involve a careful examination, X-rays, and sometimes ultrasound or MRI.

Non-surgical treatment

Footwear and padding

• Shoes with a wide, deep toe box and a low heel reduce squeezing of the forefoot. A stiffer or rocker-style sole can reduce bending forces through the ball of the foot.
• Metatarsal pads, placed just behind the painful area, help spread the metatarsal bones and take pressure off the nerve.
• For a traumatic neuroma, padding, changes in lacing, or different footwear can keep pressure off a sensitive scar.

Orthotics

Custom or prefabricated orthotics may help redistribute pressure and support the foot’s alignment.

Activity changes

Temporarily reducing high-impact activities, or changing how you train, can let an irritated nerve settle.

Medication and desensitization

Short courses of anti-inflammatory medication may help some people with Morton’s neuroma, if they are safe for you. For a painful traumatic neuroma, medicines for nerve pain (including topical options) and desensitization therapy may help; these are coordinated with your other clinicians.

Injections

A corticosteroid injection can reduce pain for some people with Morton’s neuroma. A 2024 Cochrane review of randomized trials found moderate-certainty evidence that corticosteroid and local anaesthetic injections given with ultrasound guidance probably reduce pain and improve function, while evidence for injections given without imaging guidance was less certain.^[1] An earlier review found that corticosteroid injection reduced pain more than control treatments in pooled trials.^[2]

Possible side effects include thinning of the fat pad under the foot and skin changes, so injections are limited in number and discussed in advance.

Other procedures you may read about

Alcohol (sclerosing) injections, radiofrequency ablation, cryoneurolysis and shockwave therapy have been studied for Morton’s neuroma, mainly in small or uncontrolled studies.^[2] If you have read about them, we’re happy to talk through what the evidence does and doesn’t show.

Surgical treatment

Surgery may be considered when symptoms persist and interfere with daily life despite a well-tried course of non-surgical care, and when the diagnosis is well supported. It is a decision made together, after weighing the expected benefit against the risks for you.

Surgery for Morton’s neuroma

• Neurectomy removes the thickened segment of nerve. It can be done through an incision on the top of the foot (dorsal) or on the sole (plantar). In one randomized trial, satisfaction was similar with the two approaches, although the certainty of that evidence is low.^[1]
• Ligament release divides the ligament above the nerve to relieve pressure without removing the nerve.^[4]

A systematic review of mostly case series and a few randomized trials reported better outcomes with operative treatment, while calling for better-quality trials to confirm this.^[3]

Surgery for a painful traumatic neuroma

Options described in the medical literature include removing the neuroma and relocating the nerve end into muscle or bone, freeing a nerve from surrounding scar tissue, and reconstructing the nerve with a repair, graft or conduit. Newer approaches give the regrowing nerve a target so that a painful neuroma is less likely to re-form.^[7] A meta-analysis of published studies found a meaningful reduction in pain in about three-quarters of patients overall, with no technique clearly superior — and study quality varied.^[6] See nerve repair and reconstruction.

Recovery

Recovery depends on the procedure and on you. In general:

• After Morton’s neuroma surgery, most people spend a period in a protective post-operative shoe, keep the foot elevated to control swelling, and return gradually to regular shoes and activity over the following weeks. Swelling can take a few months to settle fully.
• Numbness in the adjoining sides of the two toes is expected after neurectomy and is usually permanent.
• After surgery for a traumatic neuroma, recovery depends on the nerve and technique and often includes a period of desensitization therapy.

Risks of surgery

All surgery carries risk. Risks discussed before neuroma surgery include infection and wound-healing problems, thickened or sensitive scars, blood clots, persistent pain, and a new painful neuroma at the cut end of the nerve (a “stump” neuroma), which may need further treatment — see revision nerve surgery.^[1,5]

Questions to ask before deciding

• How confident are we about the diagnosis, and what else could be causing my pain?
• What have I tried, for how long, and is there anything left worth trying first?
• What result is realistic for me — and what would count as success?
• What will recovery involve for my work, driving and exercise?
• What are the risks for me specifically, and what happens if the pain doesn’t improve?

When to seek care

Consider an evaluation if pain in the ball of your foot, or near a scar, lasts more than a few weeks despite changing your shoes, or limits your walking, work or sleep.