Symptoms of Morton's Neuroma
Morton's neuroma typically presents with burning or sharp pain in the ball of the foot (metatarsalgia), numbness or burning that radiates to the third and fourth toes, and a characteristic sensation of "walking on a stone" around the metatarsal heads. 1, 2
Primary Sensory Symptoms
The hallmark symptoms are predominantly sensory and include:
- Burning pain in the ball of the foot, most commonly affecting the third intermetatarsal space (between the third and fourth toes) 3, 2
- Sharp or dull pain at the dorsal or plantar aspect of the forefoot 3, 1
- Numbness and tingling specifically in the third and fourth digits 1, 2
- Cramping sensation in the forefoot region 1
- Characteristic "walking on a stone" feeling around the metatarsal heads—this is a pathognomonic symptom that patients frequently describe 1
Pain Characteristics and Triggers
The pain pattern has specific features that help distinguish Morton's neuroma:
- Symptoms are typically provoked by tight, high-heeled shoes and weight-bearing activities 4
- Pain occurs while walking and during activities that compress the forefoot 4
- The condition causes significant functional impairment affecting weight-bearing activities and limiting appropriate footwear choices 5
Clinical Examination Findings
Physical examination reveals specific signs:
- Tenderness on palpation of the affected web space (usually third intermetatarsal space) 4
- Positive Mulder's click test—a palpable click when squeezing the metatarsal heads together while simultaneously compressing the neuroma 1, 4
- Positive foot squeeze test and thumb-index finger squeeze test 1
Demographics and Location
- The condition most commonly occurs in middle-aged and older women 4
- The third web space (between third and fourth metatarsals) is the most frequently affected location 3, 4
- The second interspace can also be involved 1
Important Clinical Pitfall
Motor symptoms are not characteristic of Morton's neuroma—this is a purely sensory condition affecting the interdigital nerve branches 3, 1. If motor weakness is present, consider alternative diagnoses.