Last Updated on May 28, 2025 by Andy Walker
Pain in the ball of the foot can be frustrating and disruptive, especially when every step feels like walking on something sharp or bruised. Two of the most common culprits behind forefoot pain are Morton’s neuroma and metatarsalgia. While they may feel similar at first, they are very different conditions with distinct causes, symptoms, and treatments. Understanding the differences between the two is crucial for proper diagnosis and effective relief.
Understanding Morton’s Neuroma
Morton’s neuroma occurs when the tissue surrounding one of the nerves leading to your toes thickens due to irritation or compression. Most commonly, it affects the nerve between the third and fourth toes. This nerve irritation can lead to a sharp or burning pain that radiates into the toes, often accompanied by numbness or tingling.
People with Morton’s neuroma often describe the sensation as stepping on a pebble or having something bunched up in their shoe. The discomfort is usually worse with tight or narrow footwear and may improve when shoes are removed. If untreated, the condition can become more severe and sometimes requires surgery to remove the affected nerve tissue.
What Is Metatarsalgia?
Metatarsalgia, on the other hand, is not nerve-related. It refers to generalized pain and inflammation in the ball of the foot, particularly around the metatarsal heads—the long bones just behind the toes. This condition is typically caused by overuse, poor foot mechanics, high-impact activities, or unsupportive footwear.
Pain from metatarsalgia is usually described as a dull ache or bruised feeling under the ball of the foot. Unlike Morton’s neuroma, this pain doesn’t typically radiate into the toes or involve tingling. It may worsen with activity but doesn’t usually produce the sharp, nerve-like pain seen in neuroma cases.
Key Differences at a Glance
To better understand how these two conditions differ, the table below offers a clear side-by-side comparison.
Feature | Morton’s Neuroma | Metatarsalgia |
|---|---|---|
Cause | Thickened nerve tissue | Pressure or inflammation in metatarsal bones |
Location | Between 3rd and 4th toes | Beneath the ball of the foot |
Pain Type | Burning, tingling, numbness, sharp pain | Aching, dull, bruised feeling |
Common Trigger | Tight shoes, nerve compression | Overuse, unsupportive shoes, high-impact activity |
Sensation | Feels like stepping on a pebble | Feels like walking on a bruise or stone |
Signs | Mulder’s click, radiating toe pain | Localized forefoot pressure pain |
Diagnosis | Clinical exam, ultrasound or MRI | Clinical exam, may use X-ray or MRI |
First-Line Treatment | Orthotics, shoe changes, corticosteroid injections | Footwear changes, rest, activity modification |
Advanced Treatment | Alcohol sclerosing injections or surgery | Rarely surgical |
Prognosis | May worsen without treatment | Often resolves with conservative care |
Diagnosis and Treatment
Both conditions are diagnosed through a physical examination and a detailed discussion of symptoms. Morton’s neuroma may cause a noticeable clicking sensation when pressure is applied to the sides of the foot, a test known as Mulder’s click. Ultrasound or MRI can help confirm the presence of a neuroma. For metatarsalgia, doctors look for tenderness and swelling under the metatarsal heads and evaluate gait or biomechanical stress that might contribute to pressure buildup.
Treatment plans vary depending on the diagnosis. Morton’s neuroma may respond to wider shoes, custom orthotics, or targeted corticosteroid injections. If those options fail, alcohol injections or surgical excision may be recommended. Metatarsalgia usually improves with supportive footwear, reduced activity, and physical therapy to correct foot alignment or relieve pressure.
When to Seek Help
Any persistent pain in the forefoot should prompt a visit to a healthcare professional, especially if you feel tingling, numbness, or radiating discomfort. Early diagnosis leads to better outcomes and may prevent the need for more invasive treatments down the road. By understanding the differences between Morton’s neuroma and metatarsalgia, patients can be better equipped to seek the right treatment and return to pain-free movement more quickly.
How to Buy Shoes for Morton’s Neuroma
Wearing the wrong shoes can worsen the nerve pain caused by Morton’s neuroma, especially if they’re too tight in the toe box or lack forefoot support. The key is to choose footwear that reduces pressure on the ball of the foot and gives your toes room to move.
Look for shoes with a wide toe box, cushioned soles, and low heels. Athletic shoes, supportive sandals, and orthopedic styles with shock absorption and removable insoles tend to work best. Avoid high heels or narrow shoes that compress the forefoot.
If you’re dealing with burning, tingling, or that pebble-in-your-shoe feeling, switching your shoes could make a big difference. To that end, see our top picks for the best shoes for Morton’s neuroma.
How to Buy Shoes for Metatarsalgia
Metatarsalgia causes pain and inflammation in the ball of the foot, often triggered by high-impact activity, poor foot mechanics, or unsupportive footwear. The right shoes can ease pressure on the metatarsal heads and reduce that persistent, bruised feeling underfoot.
Choose shoes with good forefoot cushioning, a roomy toe box, and strong arch support. A slightly rocker-shaped sole can also help shift pressure away from the ball of the foot. Avoid hard, flat soles or shoes with worn-down midsoles, which can worsen symptoms.
Wearing shoes designed to absorb impact and redistribute weight can make a noticeable difference in daily comfort. Here is our recommended shoes for metatarsalgia.
