Morton’s neuroma physical therapy in Carmel, Indiana

A Morton’s neuroma forms when a small nerve running between two metatarsal heads is repeatedly squeezed and rubbed, so its outer layer thickens and becomes sensitive. Despite the name it is not a tumor. It is scar-like thickening around the nerve, most often in the space between the third and fourth toes, sometimes between the second and third.

Anything that crowds the forefoot raises the pressure on that nerve. Narrow or pointed toe boxes, high heels that tip weight forward, tight cycling shoes or ski boots, and sports with long periods on the toes, such as court sports and running, are the usual suspects. Foot shape can add to it, for example a bunion that crowds the other toes or a foot that splays as the arch lowers.

Because the problem is a nerve, the symptoms often feel different from bone or joint pain: burning, electric, numb or tingling, sometimes shooting into the toes. Many people describe a sense of a bunched-up sock that will not go away.

Symptoms tend to come and go at first, flaring during a long day in dress shoes or late in a run, then fading for days. Over time, if the pressure continues, flares can become more frequent and last longer. That early, on-and-off stage is the easiest time to change course with shoes and padding.

Conservative care aims to give the nerve more room and less pressure for long enough that it calms down. The single most useful step is usually footwear: a wide, deep toe box, a lower heel and a cushioned or rocker sole. Some people find that simply loosening the forefoot laces makes a noticeable difference within days.

A metatarsal pad placed just behind the metatarsal heads can spread them slightly and lift the nerve out of the pinch. The position is precise, and a therapist can test different spots in your insole until the burning eases rather than worsens. Toe spacers suit some people and irritate others.

Exercise addresses what loads the forefoot: calf flexibility and strength so the heel does not lift early, intrinsic foot strengthening, and hip and calf work for runners and court players. Gait and stride changes may help runners who push hard off the forefoot. Manual techniques such as soft tissue work and joint mobilization of the forefoot may be used for comfort, as described on the manual therapy page.

• Shoes with a wide, deep toe box and lower heel
• Metatarsal pad positioning and insole adjustments
• Calf flexibility and strength
• Intrinsic foot muscle training
• Forefoot mobility and soft tissue techniques for comfort
• Adjusted volume for running, court sports and long standing

Swap anything narrow, pointed or high-heeled for shoes that let your toes spread, and check the fit late in the day when feet are largest. Cyclists may need to loosen or replace tight shoes, and golfers who walk the course at places around Carmel and Westfield may find a roomier golf shoe makes a long round tolerable again.

Take short breaks from standing, remove shoes and gently massage the forefoot when it flares, and reduce running or court time while symptoms settle. A simple over-the-counter metatarsal pad is low cost and worth trying, positioned behind the sore area rather than under it.

If burning or numbness keeps coming back, or you are unsure whether it is a neuroma at all, start the foot assessment questionnaire. The matching team reads it and proposes a therapist in the network with an orthopedic focus, and the cost and insurance page explains how payment works.