Condition & Treatment
Burning, numbness, and sharp pain in the ball of the foot — often described as feeling like a pebble in the shoe or a bunched-up sock. Morton's neuroma is a thickening of tissue around the nerve between the toes, most commonly the third and fourth.
Dr. Bregman offers the full spectrum of Morton's neuroma treatment — from conservative care and glucopuncture to nerve decompression surgery and stump neuroma revision. His approach prioritizes nerve preservation over nerve removal wherever clinically appropriate.
Symptoms
Diagnosis
Diagnosis begins with a thorough clinical examination. Mulder's click — a palpable and sometimes audible click produced by compressing the forefoot — is a classic finding. Tenderness in the interdigital space and reproduction of symptoms with specific maneuvers are also important diagnostic signs.
Ultrasound is the preferred imaging modality for Morton's neuroma — it is dynamic, allows real-time assessment, and can confirm the diagnosis with high accuracy. MRI may be used in select cases. Diagnostic nerve blocks can confirm the nerve as the source of pain and help predict surgical outcomes.
Treatment Options
Footwear modification, metatarsal pads, and activity modification. Appropriate for early-stage neuromas and as a first-line approach in all cases.
Corticosteroid injections reduce inflammation and provide temporary relief. Glucopuncture may reduce nerve hypersensitivity and promote healing. Sclerosing alcohol injections are used in select cases.
Surgical release of the transverse metatarsal ligament and decompression of the interdigital nerve. This approach relieves compression without removing the nerve, preserving sensation in the toes.
In cases where decompression is not appropriate or has failed, neurectomy (surgical removal of the nerve) may be indicated. This eliminates pain but results in permanent numbness in the affected toes. Dr. Bregman discusses this trade-off explicitly with every patient.
For patients who have had prior neurectomy and developed a painful stump neuroma, Dr. Bregman offers specialized revision surgery. This is a complex procedure that requires specific expertise.
Surgical Technique
The following is a live intraoperative video demonstrating Dr. Bregman's decompression technique. Rather than removing the nerve, he carefully releases the transverse metatarsal ligament and surrounding tissue to relieve compression — preserving the nerve and maintaining sensation in the toes.
* This is live surgical footage from an actual procedure. Viewer discretion is advised.
*Live surgical video — Morton's neuroma decompression by Dr. Peter J. Bregman, DPM. The nerve is preserved; compression is relieved by releasing the transverse metatarsal ligament.
Common Questions
Morton's neuroma develops when the tissue around the interdigital nerve thickens in response to chronic irritation or compression. Contributing factors include tight footwear, high heels, foot deformities (bunions, hammertoes), and repetitive stress from activities like running.
Yes — many patients respond well to conservative treatment, including footwear modification, metatarsal pads, corticosteroid injections, and glucopuncture. The success of non-surgical treatment depends on the severity of the neuroma and how long it has been present. Dr. Bregman evaluates each patient individually to determine the most appropriate approach.
Nerve decompression surgery releases the transverse metatarsal ligament and any other structures compressing the nerve, relieving pressure without removing the nerve itself. This approach preserves nerve function and avoids the permanent numbness that can result from neurectomy (nerve removal).
Neurectomy removes the affected nerve, which eliminates pain but results in permanent numbness in the affected toes. Decompression releases the compression without removing the nerve, preserving sensation. Dr. Bregman prefers decompression when it is clinically appropriate, as it avoids permanent sensory loss.
A stump neuroma is a painful nerve mass that forms at the end of a nerve that was cut during a prior neurectomy. It is a known complication of Morton's neuroma surgery and can be more difficult to treat than the original neuroma. Dr. Bregman has specific expertise in stump neuroma evaluation and revision surgery.
Recovery varies depending on the procedure performed. Most patients are walking in a surgical shoe within days of decompression surgery. Full return to normal footwear and activity typically takes 4–8 weeks. Dr. Bregman will provide specific recovery expectations based on your individual case.
Whether you are newly diagnosed or have had prior treatment that did not work, Dr. Bregman offers a thorough evaluation and a full range of treatment options.