Understanding Burning Pain in the Ball of the Foot
A Morton's neuroma is a thickening of the tissue around a small nerve that runs between the toes, most often between the third and fourth toes. The irritated nerve causes burning pain, tingling, or the feeling of standing on a pebble or a folded sock. Despite its name, it is not a tumor. Most people improve with footwear changes and injections.
Causes
Tight, narrow, or high-heeled shoes that squeeze the toes together.
High-impact activities like running or court sports.
Foot shapes such as flat feet, high arches, bunions, or hammertoes.
Repetitive pressure on the ball of the foot.
Symptoms
Burning, sharp, or electric pain in the ball of the foot that may shoot into the toes.
Numbness or tingling in two adjacent toes.
A feeling of a pebble or bunched-up sock under the foot.
Relief when removing shoes and rubbing the foot.
Imaging Studies to Consider
Ultrasound can show the neuroma and guide injections.
MRI is used when the diagnosis is unclear.
X-rays help rule out stress fractures or joint problems in the forefoot.
Physical Therapy, Home Exercise & Other Conservative Techniques
Physical Therapy
Foot and calf mobility work.
Gait and footwear assessment.
Home Exercise Program
Toe spreading and foot intrinsic muscle exercises.
Calf stretches.
Other Studied Techniques
Wide toe-box shoes with low heels.
Metatarsal pads placed just behind the painful area to spread the bones apart.
Custom orthotics.
Interventional Treatment Options
Ultrasound-guided corticosteroid injection: Reduces inflammation around the nerve; a randomized trial showed improvement compared with an anesthetic-only injection.
Ultrasound-guided nerve block: A numbing injection that can confirm the source of pain.
Radiofrequency ablation or cryoablation: Heat or cold is used to quiet the irritated nerve, for pain that returns after injections; supported mainly by observational studies.
Alcohol sclerosing injections: A series of dilute alcohol injections; results are mixed.
Surgical referral: For persistent pain, we refer to a foot and ankle surgeon to discuss nerve release or removal.
Neuromodulation: Spinal Cord & Peripheral Nerve Stimulation
Neuromodulation is rarely needed. Peripheral nerve stimulation may be considered for persistent nerve pain after neuroma surgery (stump neuroma).
Evidence Base: Guidelines & Levels of Evidence
Footwear modification and metatarsal pads: Level III · Observational studies; first-line in clinical practice
Corticosteroid injection: Level II · Randomized controlled trial vs. anesthetic alone (Thomson et al., 2013)
Radiofrequency ablation / cryoablation: Level III · Observational studies
Platelet-rich plasma (PRP): Not established · Not graded in the ASPN 2024 consensus guideline
Evidence levels and guideline citations above are summarized for general clinical reference based on the literature and major society guidelines available at the time of writing. Guidelines are periodically updated; please verify current recommendations before relying on this summary for clinical decision-making.
Pain Psychology Techniques
Pain neuroscience education about nerve pain.
Activity pacing for standing and walking.
Relaxation training and mindfulness.
Non-Opioid Medication Options
Anti-inflammatory and analgesic options
NSAIDs or acetaminophen for short-term relief.
Nerve pain (neuropathic) medications
Gabapentin, pregabalin, or duloxetine may be tried for persistent burning pain.
Topical treatments
Lidocaine patches or gel on the ball of the foot.
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Talk With Us About Your Options
Call 650-507-4113 or send us a message to schedule a consultation at our Daly City, Los Altos, or Stockton office. We will review what may be causing your pain and walk through the risks, benefits, and alternatives of each option with you.
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This information is provided for general patient education and does not replace individualized medical advice. Please discuss your specific symptoms, diagnosis, and treatment options with your pain management physician.
