If you've ever felt like there's a pebble tucked inside your shoe that isn't actually there — a burning, tingling, or numb sensation between your third and fourth toes that gets worse the longer you stand or walk — you may be dealing with Morton's neuroma. It's one of the most common causes of forefoot pain we see at DD Podiatry, and one of the most frustrating, because by the time most patients book an appointment, they've already tried wider shoes, gel pads, and simply "walking it off" for months.

Once a podiatrist confirms the diagnosis, the next question is almost always the same: what's the actual treatment, and where do I start? For most patients in Bethesda and McLean, the answer comes down to two well-studied, non-surgical options — a cortisone injection or extracorporeal shockwave therapy (ESWT). Both can relieve Morton's neuroma pain without surgery, but they work differently, carry different risks, and fit different patients. Here's how we help you decide which one to try first.

What Is Morton's Neuroma, Exactly?

Morton's neuroma isn't a tumor — it's a thickening of the tissue around one of the digital nerves that run between your metatarsal bones, most often between the third and fourth toes. Repetitive pressure or irritation causes the nerve sheath to swell, and that swelling gets compressed every time you take a step, especially in narrow or high-heeled shoes.

Common symptoms include:

• A burning or sharp pain in the ball of the foot
• The sensation of a lump, pebble, or bunched-up sock under your toes
• Numbness or tingling radiating into the toes
• Pain that worsens with tight shoes and improves when you take your shoe off and rub your foot

At DD Podiatry, we confirm the diagnosis with a physical exam and, when needed, diagnostic ultrasound to measure the size of the neuroma and rule out other causes of forefoot pain, like metatarsalgia or a stress fracture. Getting an accurate diagnosis matters here, because both cortisone and shockwave therapy are neuroma-specific treatments — they won't help pain that's coming from somewhere else in the foot.

Who Actually Gets Morton's Neuroma?

We see this condition often in the DC metro area, and a few patterns come up again and again in both our Bethesda and McLean offices:

• Women in narrow or high-heeled shoes: Morton's neuroma is roughly eight to ten times more common in women, largely because narrow toe boxes and elevated heels increase pressure on the forefoot nerves.
• Runners and court-sport athletes: The repetitive forefoot loading in running, tennis, and basketball — especially in tight athletic shoes — is a common trigger, and we see a steady stream of Bethesda and McLean runners with this exact complaint.
• Anyone on their feet all day: Retail workers, nurses, teachers, and anyone standing on hard floors for long shifts are at higher risk simply from cumulative pressure over time.
• Patients with bunions, hammertoes, or flat feet: Structural foot issues change how weight is distributed across the forefoot, which can compress the nerve between the metatarsal heads.

If any of this sounds like you, it's worth having it evaluated rather than waiting — Morton's neuroma tends to get more resistant to conservative treatment the longer it's left untreated, which is part of why we're proactive about offering both cortisone and shockwave therapy early rather than later.

Option 1: Cortisone Injections for Morton's Neuroma

A cortisone (corticosteroid) injection delivers a concentrated anti-inflammatory medication directly around the irritated nerve, usually guided by ultrasound for accuracy. It's the treatment most podiatrists reach for first because it's fast, familiar, and can provide meaningful relief within days.

Here's what the evidence and our clinical experience show:

• Fast relief: Many patients notice reduced burning and tingling within a few days of the injection.
• Moderate success rate: Cortisone injections provide good short-term relief for many patients with Morton's neuroma, though studies show pain can return within six to twelve months for roughly half of patients.
• Limited repeat use: Because repeated cortisone injections carry a real risk of thinning the natural fat pad under the ball of the foot, damaging the nerve itself, or destabilizing the small joints nearby, we generally limit patients to two to three injections in the same area over a year.

Cortisone tends to be the right first move for patients who want quick relief, have a smaller or newly diagnosed neuroma, or need to get through a specific event — a trip, a wedding, a busy work season — without surgery on the table.

Option 2: Shockwave Therapy (ESWT) for Morton's Neuroma

Extracorporeal shockwave therapy uses focused acoustic pressure waves, delivered through the skin, to stimulate healing in irritated or degenerated nerve and soft tissue. Unlike cortisone, shockwave therapy isn't primarily anti-inflammatory — it works by promoting new blood vessel formation (neovascularization) around the nerve and by desensitizing the small nerve fibers that are firing pain signals.

What makes shockwave therapy appealing for the right patient:

• No injection, no injection-related risk: There's no needle, no cortisone, and none of the fat-pad or nerve-damage risk that comes with repeated steroid use.
• Addresses the underlying tissue, not just inflammation: Where cortisone quiets inflammation temporarily, shockwave therapy is aimed at longer-term tissue remodeling.
• A short series, not a single visit: Most patients need three to five sessions, spaced about a week apart, rather than one-and-done relief.
• Best evidence in patients who haven't responded to conservative care alone: Shockwave therapy is typically positioned for patients who've already tried footwear changes, padding, or a cortisone injection without lasting results.

We already offer shockwave therapy for Morton's neuroma at both our Bethesda and McLean offices, and it's become an important option for patients who are wary of repeat injections or who simply haven't gotten lasting relief from cortisone alone.

So Which Should You Try First?

There's no single right answer for every patient — but there is a clear decision framework we walk through with patients in Bethesda and McLean:

• Try cortisone first if: this is your first treatment for a newly diagnosed, relatively small neuroma, you need relief quickly, and you're comfortable with an injection.
• Consider shockwave therapy first (or next) if: you've already had one or two cortisone injections without lasting relief, you'd rather avoid the fat-pad and nerve risks of repeat steroid use, or your neuroma has been present long enough that we're more concerned with tissue remodeling than short-term inflammation.
• Combine both, in sequence, if: many of our patients actually use cortisone for a short-term bridge to calm the acute pain, then move into a shockwave series to address the nerve irritation more durably — without needing repeat injections.

Surgery to remove the neuroma is still an option for cases that don't respond to either conservative treatment, but the vast majority of patients we see in Bethesda and McLean never need it once we've worked through cortisone and shockwave therapy in the right order for their specific case.

What to Expect at Your Visit

If you're dealing with burning, tingling, or "pebble-in-my-shoe" pain in the ball of your foot, your first visit with us will include a hands-on exam, a discussion of your footwear and activity level, and — if needed — an in-office ultrasound to confirm the neuroma and measure its size. From there, we'll walk you through whether cortisone, shockwave therapy, or a combination makes the most sense for your specific situation, your timeline, and how much you've already tried on your own.

Most patients start feeling meaningful improvement within one to three weeks of starting treatment, whether that's from an injection or the first couple of shockwave sessions. We track your progress at each visit and adjust the plan rather than locking you into one treatment if it isn't working.

Common Questions About Cortisone vs. Shockwave for Morton's Neuroma

Does insurance cover these treatments? Cortisone injections are typically covered by insurance when medically necessary. Shockwave therapy coverage varies by plan — our team verifies your specific benefits before you start treatment, at both our Bethesda and McLean locations.

How many cortisone injections can I safely get? We generally recommend no more than two to three injections in the same spot within a twelve-month period, specifically to avoid fat-pad thinning and nerve damage. If you need relief beyond that, shockwave therapy is usually the better next step rather than another round of cortisone.

Is shockwave therapy painful? Most patients describe it as a tapping or mild discomfort rather than sharp pain, and there's no downtime — you can walk out of either office and go straight back to your day.

What if neither treatment works? A small percentage of patients don't get lasting relief from cortisone or shockwave therapy alone. In those cases, we discuss minimally invasive surgical removal of the neuroma, which has a high success rate as a last-resort option.

Why Bethesda and McLean Patients Choose DD Podiatry

DD Podiatry was built around regenerative and minimally invasive treatment of the foot and ankle — Morton's neuroma care is a good example of that philosophy in action. We don't default to surgery, and we don't default to a single injection and a "come back if it doesn't work" plan, either. Our team, led by Dr. Nam Tran and Dr. Miriam Niktash, uses ultrasound-guided precision for injections and evidence-based shockwave protocols to give patients in both Bethesda, MD and McLean, VA a real, staged plan for lasting relief.

If forefoot pain has been slowing you down, you don't have to keep guessing between wider shoes and hoping it goes away. Call us at (301) 363-2676 or book online to schedule a consultation at our Bethesda or McLean office, and we'll help you figure out whether a cortisone injection, shockwave therapy, or both is the right place to start.