Morton's Neuroma: Diagnosis and Injection Approach

Written by Gisele J. Girault, MD

Updated September 2026 ·9 min read

Morton’s neuroma is one of the easiest forefoot diagnoses to make and one of the easiest injections to get wrong, and both facts come down to the same thing: exactly where the patient points, and which surface of the foot the needle enters through.

Dr. Gisele J. Girault describes it as a problem that announces itself. It is “a very specific area of pain. Patients will point directly at it. They will point right to it.” On examination a small nodule can usually be palpated — the thickened tissue around the interdigital nerve that gives the condition its name.

Despite the name, it is not a tumour. The swelling is fibrous thickening around a nerve compressed between the metatarsal heads, most often in the third interspace, and the symptoms are the nerve’s: burning, a sensation of standing on a pebble, numbness between the toes.

This reference covers how it presents, how it is distinguished from the other causes of forefoot pain, and the injection approach. It sits under our clinical reference to joint and extremity injection.

Morton’s neuroma symptoms

The functional impact is what usually brings the patient in rather than the pain at rest. Girault is direct about how limiting it becomes: Morton’s “can be actually very painful. It can be painful for patients to wear a shoe or, or even to walk.”

Three features make the diagnosis straightforward:

• Pinpoint localisation. The patient identifies the site themselves, between the metatarsal heads rather than over a joint or under the heel
• A palpable nodule. Usually appreciable through the skin, and tender on compression
• Neural quality. Burning or numbness radiating into the adjacent toes, rather than the aching of a joint

Footwear matters because the mechanism is compression. Narrow toe boxes and elevated heels push the metatarsal heads together and load the interspace, which is why symptoms track with what the patient is wearing.

Distinguishing it from the other causes of foot pain

Forefoot and plantar pain has several common explanations, and the site plus the presence or absence of numbness separates most of them.

Plantar fasciitis produces heel pain, characteristically worst on the first steps of the morning, and without numbness. It is treated at a different target entirely — see plantar fasciitis injection.

Tarsal tunnel syndrome produces pain and numbness around the medial malleolus and along the plantar surface, and Girault notes it is often confused with plantar fasciitis because the distributions overlap. Her distinguishing feature is numbness: present in tarsal tunnel, usually absent in plantar fasciitis. It is covered in tarsal tunnel syndrome.

Diabetic peripheral neuropathy is symmetrical, affects both feet, and follows a stocking distribution rather than pointing at one interspace. Girault treats it as its own entity, blocking the five nerves of the ankle rather than a single focal target.

Metatarsophalangeal joint pain and bunion pain localise to the joint itself rather than to the space between the metatarsal heads.

Where the picture is mixed — forefoot symptoms in a diabetic patient, for instance — electrodiagnostic testing separates a focal problem from a generalised neuropathy, a distinction that changes what treatment is worth attempting.

The injection approach, and why it comes from the top of the foot

This is the part of the technique Girault is most emphatic about, and the reasoning is entirely about tissue.

The neuroma can be palpated from either surface, but the injection is given through the dorsum — the top of the foot. Her reason: “going through the plantar surface of the foot is very painful. I try to avoid that at all costs.” The only plantar injection she performs is the one for plantar fasciitis.

What makes the dorsal approach tolerable is straightforward anatomy: “the skin’s a lot thinner. There’s not a plantar fascia on top of the foot, so you’re not going through a thick fascia layer.” The sole is built to bear weight; the top of the foot is not, and a needle passing through it meets far less resistance and far fewer nerve endings.

The target is the tissue around the swelling rather than the swelling itself. Girault injects around the neuroma, not directly into it — the aim is to reduce the inflammation compressing the nerve rather than to instrument the nerve.

Her preparation is a 50/50 mixture of steroid and lidocaine, delivered through a 30-gauge half-inch needle, roughly one cc. Ice or cold spray applied beforehand takes the edge off the skin entry.

How often the injection can be repeated

Girault works to a defined schedule rather than injecting on demand.

A course is a series of three injections, spaced every two to three weeks. That series can be repeated approximately every six months.

Where a patient’s pain returns before the six-month point, she augments with straight lidocaine rather than bringing the steroid forward — a way of managing the interval without accumulating steroid exposure in a small, tendon-dense region of the foot. The rationale behind steroid selection and cumulative dosing is set out in corticosteroid injections.

What the injection does and does not change

It is worth being clear with patients about the target. The injection reduces inflammation around a compressed nerve; it does not remove the thickened tissue, and it does not change the mechanics that produced the compression.

That is why footwear modification belongs with the injection rather than after it has failed. A wider toe box and a lower heel reduce the load that recreates the problem, and an injection that buys comfortable months is doing its job even though the nodule is still there.

Where a well-placed series gives no meaningful relief, the diagnosis deserves rechecking before the course is repeated — a metatarsal stress fracture, a plantar plate injury or a generalised neuropathy will not respond to a target that was never the problem.

For clinicians

Forefoot injection is palpation-guided work in a small space with tendons and vessels close by, learned on live anatomy under supervision. This reference carries no needle depths or angles for that reason. Empire teaches the foot and ankle injections alongside the ankle block across the pain management academy.