How Custom Orthotics Help Morton’s Neuroma: Pain Relief Without Guesswork

Morton’s neuroma is an irritated nerve between the metatarsal bones (most often between the 3rd–4th toes). Custom orthotics help by spreading pressure away from the nerve, stabilizing the foot, and opening the forefoot space with a precisely placed metatarsal dome. Add the right shoes and a short break‑in plan, and most people feel meaningful relief within weeks.

What is Morton’s neuroma?

Morton’s neuroma is a painful thickening/irritation of a digital nerve beneath the ball of the foot—typically between the 3rd and 4th metatarsal heads. Common symptoms include burning, sharp/zinging pain, numbness or tingling into the toes, and the classic feeling of a “pebble in the shoe.” Symptoms can flare with tight shoes, high heels, long walks, or forefoot‑heavy workouts.

A visual of a Morton’s Neuroma

Why it happens

• Compression: The nerve runs under a ligament in a tight space. Narrow toe boxes and high heels compress that space.

• Shear & instability: Excess pronation or forefoot instability can cause repeated rubbing on the nerve.

• Impact load: Long days on hard floors or high‑impact sport increase pressure at the metatarsal heads.

How custom orthotics reduce neuroma pain

Orthotics aren’t just “arch supports.” For neuromas, three design levers matter most:

1. Metatarsal dome (the game‑changer)
   A small, firm pad is placed just behind the metatarsal heads (not under them). This gently spreads the metatarsals, decreases focal pressure on the nerve, and opens the intermetatarsal space. Positioning within a few millimetres is critical—too far forward can be irritating; too far back does nothing. We test position in‑clinic and fine‑tune at your fitting.

2. Load shift off the forefoot
   A contoured arch with a deep heel cup and appropriate rearfoot/forefoot posting moves some load from the ball of the foot to the midfoot/heel. Less forefoot pressure = fewer nerve flare‑ups.

3. Motion control = less shear
   Stabilizing excessive pronation or forefoot instability reduces side‑to‑side rubbing over the nerve. Subtle forefoot posting (valgus/varus), a slight metatarsal cut‑out, or a softer topcover can further calm symptoms.

Custom vs. off‑the‑shelf inserts

• Custom: The met dome is mapped to your scan and pain point, then tuned at fitting—often within 24–48 hours thanks to our in‑house 3D printing. Materials and posting are tailored to your foot type and shoes.

• OTC: A generic arch with a generic dome. Can help mild cases, but placement is guesswork and often misses the mark.

What to expect at your appointment

1. Assessment & Gait Analysis – We pinpoint the neuroma location, check footwear, and evaluate mechanics that may be driving symptoms.

2. 3D Scan & CAD Design – We set arch contour, posting, and met dome position on your digital model.

3. In‑house 3D Printing – Your orthotics are produced on‑site—often ready within 24–48 hours.

4. Fitting & Break‑In Plan – We fine‑tune dome position on the spot and outline a short ramp (see below).

5. Follow‑Up & Free Adjustments – Minor tweaks (dome size/position, topcover changes) are common and included within the review window.

Break‑in plan

• Days 1–2: 1–2 hours total wear/day around home.

• Days 3–5: 3–4 hours/day; light walks only.

• Days 6–10: Up to full‑day wear as comfortable.
  Mild pressure under the arch/dome is normal early on; sharp pain or rubbing is not—come back for a tweak.

Shoes that help a neuroma

• Wide toe box to reduce squeeze (think: plenty of forefoot width).

• Low to moderate heel—avoid steep heels that drive weight onto the ball of the foot.

• Removable liner & adequate depth to fit the orthotic + dome.

• Rockered soles can unload the forefoot during push‑off.

Bring your most‑worn shoes to your assessment; we’ll match the orthotic to those.

Pair orthotics with simple home strategies

• Activity tweaks: Shorten high‑impact bouts while flared; switch to cycling/elliptical temporarily.

• Calf & forefoot mobility: Gentle calf stretching and metatarsal mobilization help reduce forefoot pressure.

• Icing/massage: 5–10 minutes after activity can calm a flare.

• Toe spacers: Can feel good in wide shoes; use short‑term and stop if symptoms worsen.

If pain is severe, night‑waking, or worsening despite changes, we’ll discuss next steps.

When orthotics aren’t enough

Corticosteroid injections, sclerosing therapy, or (rarely) surgery may be considered in stubborn cases. We’ll outline pros/cons and timing if needed.

FAQ

How soon will I feel relief?
Many feel improvement within 2–4 weeks of consistent wear; stubborn cases take longer and may need an adjustment visit.

Will I always feel the metatarsal dome?
A mild “presence” is common at first. It should settle within days after proper placement. If it feels pokey, we’ll resize or reposition it.

Can I move my orthotics between shoes?
Often, yes—provided the shoes have removable liners and enough depth. Some patients choose a second pair to avoid swapping.

Are custom orthotics covered?
Most extended health plans in Ontario cover custom devices dispensed by a chiropodist/chiropody clinic. We’ll supply the paperwork and gait/assessment notes insurers often require.

Ready to walk without the pebble‑in‑shoe feeling?

Book a 30‑minute Orthotic Assessment in Hamilton. With on‑site 3D printing, we can often design, produce, and fit your orthotics within 24–48 hours—and adjust them at your follow‑up until they’re just right.