Bursitis and Morton’s Neuroma

Reviewed by Janet D. Pearl, MD, MSc

Morton’s neuroma is a fairly common cause of foot pain that is reported far more frequently in females as compared to males (female to male ratio is 9:1). This high incidence is attributed mainly to the anatomy of female foot as well as lifestyle choices such as prolong use of narrow toe-box shoes or long hours of standing etc. Unfortunately, poorly managed foot pain can also aggravate the risk of developing other disorders such as bursitis.

Morton's neuroma anatomy

Typical Presentation of Bursitis and Morton neuroma:

  • Excruciating pain that is often especially pronounced in the region of third and/ or fourth metatarsal space.
  • Aggravation of pain or discomfort upon weight bearing.
  • Feeling of electrical jolt like sensation; especially on the movement of the involved toes
  • Feeling of numbness radiating to the involved web-spaces
  • Sensation of walking on a marble
  • Progressive disability

However, in some cases the two conditions may coexist asymptomatically i.e. without any pain or noticeable symptoms.

Diagnosis of Bursitis and Morton’s neuroma

The diagnosis of Morton neuroma and bursitis is mostly clinical i.e. more than 85-90% cases can be identified on good history taking and clinical examination. For more complex or concealed cases, radiological tests like an ultrasound or magnetic resonance imaging (MRI) may be needed.

bursitis and morton's neruoma

Bursitis can be differentiated from the Morton neuroma on scans via following features:


  • Morton neuroma appears as patchy enhancement (which is actually perineural fibrosis). The lesion is characteristic for a tear-drop shaped mass of soft tissue; usually along the plantar aspect of metatarsal heads.
  • Bursitis appears brighter and has signs of rim enhancement. Often times the bursitis may show signs of fluid accumulation around the tissues due to ongoing inflammation.

Management of Bursitis and Morton neuroma

Generally no management or clinical workup is necessary if Morton neuroma is pain free and  identified accidentally on physical examination. For painful or disturbing neuromas, the choice of therapy depends on overall health and patient factors.

Most common management tools to control the symptoms of these two conditions primarily revolves around:

In chronic cases:



  1. Bauer, T., Gaumetou, E., Klouche, S., Hardy, P., & Maffulli, N. (2015). Metatarsalgia and Morton’s Disease: Comparison of Outcomes Between Open Procedure and Neurectomy Versus Percutaneous Metatarsal Osteotomies and Ligament Release With a Minimum of 2 Years of Follow-Up. The Journal of Foot and Ankle Surgery, 54(3), 373-377.
  2. Zanetti, M., Strehle, J. K., Zollinger, H., & Hodler, J. (1997). Morton neuroma and fluid in the intermetatarsal bursae on MR images of 70 asymptomatic volunteers. Radiology, 203(2), 516-520.

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