The most common causes are: years of wearing narrow, tight or high-heeled shoes that squeeze the toes together, foot shape (high arches, flat feet, bunions or hammer toes that change pressure distribution), repeated impact from running or sports and being female (it's around 8 times more common in women than men). Occasionally a single trauma triggers it.

Classic symptoms are: sharp, burning or shooting pain in the ball of the foot, usually between the third and fourth toes; numbness or tingling in the affected toes; the sensation of walking on a stone or wrinkled sock; pain that's worse in tight shoes or after standing for a while; relief when you take your shoe off and massage the foot. Some people feel a clicking sensation between the toes (Mulder's click).

Diagnosis is usually made at clinical examination. The podiatrist palpates the ball of the foot to identify tenderness in the affected web space, performs Mulder's compression test (squeezing the foot to reproduce the clicking and pain) and assesses your gait and footwear. Ultrasound or MRI is sometimes used to confirm and measure the neuroma if the diagnosis is unclear or you're not responding to treatment.

We treat in a stepped approach starting with the least-invasive options:

• Footwear changes (wider toe box, lower heel, softer sole)
• Custom orthotics with a metatarsal dome to offload the nerve
• Focused shockwave therapy for stubborn cases
• GP referral for diagnostic ultrasound and possible steroid injection
• Surgical referral as a last resort (rarely needed)

Around 80 percent of patients improve significantly without surgery.

Mild cases often improve within 4 to 8 weeks of footwear and orthotic changes. Moderate cases typically respond to a comprehensive programme over 8 to 12 weeks. Severe long-standing cases may take longer or need additional interventions like injection. We'll give you a realistic timeline at your first appointment.

Most patients do not need surgery. Around 80 percent improve significantly with conservative care including footwear changes, orthotics and (where appropriate) shockwave or injection. Surgery to remove the neuroma is a last resort for cases that don't respond to other options and is usually very effective when needed. We'll discuss referral if it becomes the right next step.

Common aggravating factors: tight, narrow or pointed shoes; high heels (which push weight onto the ball of the foot); prolonged standing on hard floors; running on hard surfaces; tight calves which alter weight distribution; and continuing to push through the pain rather than addressing it.

Several things help:

• Wear shoes with a wide toe box and low heel
• Avoid high heels, narrow shoes and barefoot walking on hard floors
• Use a metatarsal pad in your shoes (we'll show you where to position it)
• Stretch your calves daily
• Ice the ball of the foot after a long day
• Take breaks during prolonged standing or walking

Yes, especially if the underlying causes (footwear, foot shape, activity level) aren't addressed. Around 30 percent of treated cases recur within 5 years if the patient returns to the shoes or activities that caused it. Long-term management is about staying in appropriate footwear, using orthotics and avoiding the triggers.

Morton's neuroma is not dangerous and doesn't damage other parts of the foot. However, persistent untreated cases can become very disabling — limiting what you can do, what you can wear and how long you can stay on your feet. Some patients also change their gait to avoid pressure on the foot, which can cause secondary problems in the knees, hips or back.

Most patients notice some improvement within 2 to 4 weeks of footwear and orthotic changes. Significant improvement typically by 6 to 8 weeks for moderate cases. Stubborn cases may take 3 to 6 months but the majority avoid surgery with the right combination of treatments.

For your first appointment, allow up to 60 minutes. This gives us enough time for a thorough history, examination and treatment in the same visit. Follow-up treatments are typically up to 30 minutes for the vast majority of cases. We'll confirm the exact length when you book.

No. You can book a podiatry appointment directly with us with no GP referral needed. We can write to your GP after your appointment if there's anything they should know.

Wear something comfortable that's easy to roll up to the knee. Bring the shoes you wear most often (we'll often look at how they're wearing for biomechanical clues). If you've had any imaging or test results related to your feet, bring those too. Otherwise just bring yourself.

Podiatry & chiropody is available at our Great Dunmow clinic at 12 Stortford Road, CM6 1DA. The clinic has on-site disabled parking available on request. Just give us a call ahead of your appointment.