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Living with Morton’s Neuroma can feel like there’s a pebble constantly in your shoe – every step is a sharp reminder of the pain. If you’ve been struggling for months with burning or stabbing sensations in the ball of your foot, you’re not alone. Many people grow frustrated after trying rest, orthotics, or even injections, only for the pain to persist. The good news is that there’s a non-surgical option you may not have tried: shockwave therapy. This evidence-based treatment has been gaining attention as a way to relieve Morton’s Neuroma pain by targeting the problem at its source. In this article, we’ll explore what Morton’s Neuroma is, why it can become a chronic issue, and how extracorporeal shockwave therapy (ESWT) may offer hope for lasting relief. Results may vary; always consult a healthcare provider before starting new treatments.
Morton’s Neuroma is essentially a pinched nerve in the foot. It involves a thickening of one of the interdigital nerves (usually between the third and fourth toes) due to chronic irritation or compression. This enlarged, inflamed nerve can cause burning pain, tingling, or numbness in the ball of the foot and between the toes. Many people describe it as feeling like they’re “walking on a marble” inside their shoe. Women are nearly ten times more likely to develop Morton’s Neuroma than men, often attributed to years of wearing tight or high-heeled shoes that squeeze the forefoot. Over time, repetitive pressure and micro-trauma lead to perineural fibrosis (scar tissue around the nerve) and nerve degeneration, making the pain more persistent.
Morton’s neuroma involves a swollen, irritated digital nerve (often between the 3rd and 4th metatarsals), leading to forefoot pain.
Acute foot pain can turn into a chronic neuroma when underlying issues aren’t addressed. Commonly, people initially try home remedies like rest, ice, padding, or over-the-counter pain relievers. These may provide temporary relief but often don’t fix the root cause – the mechanical compression and nerve irritation remain. If ill-fitting shoes or high-impact activities continue, the nerve keeps getting aggravated, and the cycle of inflammation continues. In some cases, the neuroma can enlarge or the nerve damage can become more established, causing pain that lasts longer than 3 months and resists standard treatment.
Typical Treatment Paths and Frustrations: Early on, doctors usually recommend conservative measures. Changing to wider, supportive footwear and adding metatarsal pads or custom orthotics can offload pressure from the nerve. Physical therapy exercises and calf/Achilles stretches may help improve foot biomechanics. Anti-inflammatory medications or cortisone injections are also common; in fact, corticosteroid injections have been a mainstay treatment and can yield significant pain reduction with about 50% of patients reporting being pain-free at 1 year. However, many patients find that these injections, while helpful, may only offer partial or short-term relief. Repeated steroid shots can have diminishing returns and potential side effects (like tissue weakening). Other nonsurgical options include alcohol sclerosing injections or radiofrequency ablation, which attempt to destroy the nerve tissue – these can work for some, but results are mixed and may be accompanied by post-procedure pain or numbness.
When conservative methods fail, surgery is often presented as the next step. The typical surgical procedure (neurectomy) involves removing the affected portion of the nerve. Surgery boasts high success rates (around 80–90% relief in many reports), but it’s a last resort for a reason – it’s invasive, requires downtime, and results in permanent numbness between the toes (since the nerve is cut). There’s also the usual surgical risk of infection or complications, and a chance of stump neuroma (regrowth of nerve tissue causing recurrent pain). Understandably, many patients are hesitant to undergo surgery if another option could spare them from the scalpel.
Enter shockwave therapy: Shockwave offers a compelling middle-ground – a non-surgical, low-risk treatment that aims to break the pain cycle by healing the nerve instead of removing it. Before we dive into how Unpain Clinic applies this therapy, let’s review what the research says about shockwave therapy for Morton’s Neuroma.
Shockwave therapy, or Extracorporeal Shockwave Therapy (ESWT), involves sending high-energy sound waves into injured tissue to stimulate a healing response. It has a proven track record in treating chronic foot conditions like plantar fasciitis and Achilles tendinopathy. But how does it fare for a nerve issue like Morton’s Neuroma? The evidence specific to Morton’s Neuroma is still emerging and somewhat limited, yet promising.
Clinical Evidence: A handful of peer-reviewed studies have explored ESWT for Morton’s Neuroma, including two randomized controlled trials and a comparative clinical series:
Pain Reduction: A 2016 randomized, placebo-controlled trial in the Journal of the American Podiatric Medical Association found that patients who received shockwave therapy for Morton’s Neuroma had significantly lower pain scores (measured by Visual Analog Scale) at 1 week and 4 weeks post-treatment, compared to their baseline. In contrast, a sham (placebo) treatment group saw no significant change. Functional foot scores (AOFAS scores) also improved in the ESWT group after 4 weeks. The shockwave didn’t visibly shrink the neuroma on ultrasound in that short timeframe, but it clearly reduced patients’ pain and improved function relative to doing nothing.
Alternative to Surgery: An earlier study in 2009 also tested shockwave vs. sham treatment. After 1, 6, and 12 weeks, the shockwave group showed significant pain reduction, whereas the placebo group did not. The authors concluded that shockwave therapy could be a potential alternative to surgical excision for Morton’s Neuroma. In other words, for some patients, a course of shockwave might alleviate pain enough that surgery isn’t necessary.
Comparative Success Rate: Most recently, a 2022 prospective study compared focused shockwave therapy head-to-head with surgery (neurectomy) in 32 patients with stubborn Morton’s Neuroma. The results illustrated a trade-off: the surgical group had a higher rate of “good” outcomes (93% of patients improved) versus ~71% in the shockwave group. However, about 70% improvement is still quite high for a non-invasive treatment. The shockwave group had more modest results in some cases (approximately 29% reported only slight or no improvement, compared to ~7% in the surgery group). The key takeaway from this study was that shockwave therapy, while a bit less immediately effective than surgery, still helped the majority of patients – and with far fewer risks. The authors noted that given its non-invasive nature and low complication rate, ESWT “can be considered an option prior to minimally invasive and surgical techniques”.
It’s important to note that, as of now, medical literature for shockwave in Morton’s Neuroma is not as abundant as it is for other treatments. A 2020 systematic review of Morton’s Neuroma treatments commented that there is “minimal evidence for the use of shockwave therapy” in this condition so far. This means that while the studies we do have are encouraging, we simply need more research and larger trials to fully confirm how effective ESWT is for neuromas. In contrast, treatments like steroid injections have a longer track record of study (hence being often recommended as first-line). So, if you discuss shockwave therapy with a podiatrist or physician, don’t be surprised if they mention that the evidence, though positive, is still emerging.
How Shockwave Therapy May Help: Despite the limited quantity of studies, the quality of results and the known mechanisms of shockwave therapy both suggest it can offer genuine relief for Morton’s Neuroma:
Stimulating Healing: Shockwaves trigger a controlled micro-trauma in tissues that jump-starts the body’s natural healing processes. In tendons and bones, this leads to release of growth factors and formation of new blood vessels (neovascularization). In the case of a nerve lesion like Morton’s Neuroma, the therapy may help by increasing local blood circulation and promoting regeneration of the nerve’s myelin sheath (its protective covering), thereby aiding recovery of the nerve. Researchers have observed that ESWT “accelerates healing, stimulating metabolism and enhancing blood circulation” in the affected area.
Pain Modulation: Shockwave therapy also has an analgesic (pain-reducing) effect. The acoustic waves can overstimulate nerve endings in a way that ultimately desensitizes them, much like “resetting” how the nerve transmits pain. Patients often report a numbing or dulling of pain after a session. One theory is that shockwaves induce the release of substance P and other neurotransmitters that modulate pain signaling, resulting in reduced pain perception over time. In simpler terms, ESWT may calm down an overactive nerve. In fact, some foot specialists use shockwaves to “help desensitize nerve endings, reducing the irritation associated with Morton’s Neuroma” as well as to soften any scar tissue around the nerve.
Tissue Remodeling: Morton’s Neuroma often involves a fibrous tissue build-up around the nerve. Shockwaves have mechanical effects that can break up calcifications and fibrous adhesions in tissues (this is one reason it’s great for plantar fasciitis and calcific tendonitis). There’s hope that ESWT might similarly help diminish the thickened tissue around the nerve or at least improve the elasticity of the surrounding ligamentous structures, relieving pressure on the neuroma.
Treatment Protocol and Expectations: If you decide to try shockwave therapy for Morton’s Neuroma, what should you expect? Typically, a course of shockwave involves multiple sessions rather than a one-and-done treatment. In studies, protocols have varied – some used a single high-energy session, while others used weekly sessions for 3–5 weeks. In clinical practice at Unpain Clinic, shockwave therapy for a chronic foot condition is often delivered once per week over several weeks. Each session might last around 5–10 minutes of actual shockwave application to the foot (the machine makes rapid percussive “tapping” sounds as it sends the waves through a hand-held applicator).
Shockwave therapy doesn’t require anesthesia; it can be a bit uncomfortable (imagine a strong, deep vibration or tapping sensation). However, most people tolerate it well – any pain during treatment is usually brief and subsides quickly. (To answer a common patient question: No, shockwave therapy is not usually described as “painful” – more like unusual and a little uncomfortable, but bearable. The intensity can also be adjusted to your comfort.) After a session, you might leave with your foot feeling slightly sore or tingly, as if it had a good deep massage. There is no downtime – you can walk out and continue your day.
Improvements in symptoms often occur gradually. Some people notice their foot feels a bit better after the first one or two sessions; for others, it may take a full cycle of treatments (e.g. 4–6 sessions over a month or two) to really appreciate the change. Remember, shockwave’s magic is in stimulating healing – and healing takes time. In the studies, significant pain reductions were seen at the 4-12 week mark after treatment. So, patience is key. The payoff, if it works for you, is enjoying relief without having undergone an invasive procedure.
It’s also crucial to have realistic expectations. Shockwave therapy is not a guaranteed “cure” for every case of Morton’s Neuroma. As the evidence showed, some patients may not respond sufficiently and might still opt for surgery in the end. However, considering its safety profile – with essentially no serious side effects in the context of musculoskeletal use – many clinicians and patients feel it’s well worth a try before resorting to an operation. In summary, research suggests shockwave therapy may help reduce chronic pain from Morton’s Neuroma, and while more studies are needed, it offers a hopeful option especially for those seeking to avoid surgery.
At Unpain Clinic, shockwave therapy is one of our core specialties – and we’ve seen first-hand how even the most stubborn foot pains can improve when we approach them the right way. Our philosophy is to find the “why” of your pain, not just treat the “where.” Morton’s Neuroma might be centered in the foot, but often there are underlying contributors (such as tight calf muscles, altered walking patterns, or old injuries up the chain) that set the stage for the neuroma to form. In an episode of the Unpain Clinic Podcast, “Understand and Fix Your Chronic Foot Pain” (June 18, 2021), Uran Berisha emphasizes looking beyond the foot: issues like ankle stiffness or glute weakness can force the forefoot to overload, perpetuating conditions like plantar fasciitis or neuromas. With this whole-body perspective, we tailor our treatment plan to each patient rather than doing the same cookie-cutter protocol for everyone.
Comprehensive Assessment: When you come in with forefoot pain, we start with a thorough assessment. We’ll confirm the diagnosis (Morton’s Neuroma vs. other causes of metatarsal pain, like metatarsalgia or stress fractures) and evaluate factors such as your foot arch mechanics, calf flexibility, gait (how you walk), and even hip and lower back function. This matters because, for instance, if your ankle doesn’t dorsiflex well, you might put extra pressure on the ball of the foot with each step. Or if your hips are weak, your forefoot may grip harder to push off. We want to address those root causes in parallel with treating the neuroma itself. (As Uran often says, “the site of the pain is not always the source of the pain.”)
Shockwave Therapy Sessions: Assuming you’re a good candidate for shockwave (see the FAQ on who shouldn’t have it), we incorporate True Shockwave™ therapy as a primary modality in your treatment plan. At Unpain Clinic, we use advanced shockwave equipment (Storz Medical devices) that allow both focused shockwave and radial shockwave application. For Morton’s Neuroma, we typically use focused shockwaves to concentrate the energy precisely at the neuroma site between the metatarsals. The practitioner will apply a gel on the foot and then press the handpiece to the skin between your toes/over the forefoot. You’ll hear clicking sounds and feel tapping pulses. We adjust the intensity to a therapeutic level you can tolerate – it needs to be strong enough to stimulate tissue change, but we don’t want you jumping off the table! The session is relatively quick.
We usually schedule one session per week, and a typical treatment course might be 3–6 sessions depending on severity and your response. During the weeks of treatment, we advise you on activity modification (you don’t need strict rest, but we’ll ask you to avoid high heels, high-impact running, or anything that clearly aggravates your foot for the time being). Many patients start noticing improvement in pain after a couple of sessions – maybe the sharp zing between the toes is less frequent, or the foot ache at day’s end isn’t as intense. By the end of the full course, our goal is that you can walk and even jog or jump without that familiar pain shooting through your toes.
Multimodal Approach: While shockwave therapy is the star of the show, we often combine it with other supportive therapies to maximize results. For example, we may do manual therapy to address any joint restrictions in the foot or ankle. Gentle joint mobilizations or soft tissue release around the metatarsals can improve the space between those bones, taking pressure off the nerve. We also employ neuromodulation techniques – this could include simple things like nerve gliding exercises, or using other technologies like PEMF/EMTT (pulsed electromagnetic field therapy) to calm nerve irritability. In fact, at Unpain Clinic we often pair shockwave with a modality called NESA or EMTT in the same session if appropriate, to synergistically soothe the nerve. Additionally, we’ll guide you through specific exercises: perhaps toe spreading exercises to keep the forefoot flexible, calf stretching and foot intrinsic muscle strengthening to support your arch (and thereby reduce pressure on the neuroma area). Our team’s experience has shown that addressing muscle imbalances and movement patterns makes a significant difference in preventing the neuroma pain from returning. As Uran Berisha described in a recent podcast, “Shockwave therapy is one of the most effective tools we use. It uses sound waves to regenerate soft tissue, improve blood flow, and stimulate the body’s natural healing response” – but for lasting relief, we also work on the factors that caused the tissue to break down in the first place.
Tracking Progress: Throughout your shockwave treatment plan, we continuously monitor your progress. Each visit, we’ll ask how your pain has been (Did the character of the pain change? Any improvement in duration or intensity? Can you do more before pain sets in?). We may repeat outcome measures, like a pain scale or a simple functional test (for example, the pencil test – squeezing the forefoot to see if it reproduces the neuroma pain – which initially might have been very positive, we hope to see it become negative or much less painful after treatment). If you’re improving as expected, we’ll complete the planned sessions and then re-evaluate whether any further treatments are needed. If you’ve reached a satisfactory level of pain relief, we then transition you fully into a maintenance/rehab program of exercises and preventative care (so the problem stays gone).
One thing we pride ourselves on at Unpain Clinic is honesty and transparency. If, for some reason, shockwave therapy isn’t helping you as much as we hoped after a reasonable trial (usually we’d know by 3–4 sessions if it’s going to work well), we will tell you and adjust course. That could mean referring you for further diagnostic tests (maybe an MRI to confirm the diagnosis or see if something else is lurking), or referring you to a specialist to discuss other options like injection or surgery. Our goal is the same as yours – to get you pain-free and back to the activities you love. We won’t string you along for endless sessions if the results aren’t there. Fortunately, for many of our patients with foot pain, shockwave has been a game-changer, helping them avoid more invasive procedures.
To sum up, Unpain Clinic’s approach to Morton’s Neuroma is a blend of high-tech regenerative therapy (shockwave) and personalized rehabilitative care. We treat you as a whole person, not just a foot, and we prioritize long-term recovery over short-term bandaids. It’s immensely rewarding to see someone who hobbled into our clinic finally walk out with a spring in their step, knowing they have a plan in place to stay pain-free.
(While this is not an actual patient testimonial, it’s a realistic example based on common experiences we see. Individual results vary, and this story is for illustrative purposes only.)
Meet Sarah: Sarah is a 47-year-old avid golfer and office worker who came to Unpain Clinic with a 2-year history of Morton’s Neuroma pain in her right foot. She recalled that it started as a mild tingling between her 3rd and 4th toes, which she mostly felt after wearing her tight dress shoes all day. Over time, it worsened to a sharp, burning pain every time she walked more than a few minutes. She often felt like there was a rock in her right shoe. Eventually, Sarah had to quit her weekly golf outings and could barely get through grocery shopping without limping.
Frustration with Traditional Treatments: Before finding us, Sarah had tried “everything.” Her podiatrist had confirmed Morton’s Neuroma and fitted her with custom orthotic insoles and a metatarsal pad. These helped a little, but not enough – she still couldn’t walk long distances without pain. She had a corticosteroid injection that made the pain disappear for about 6 weeks, only for it to roar back. A second injection didn’t seem to help at all. She was taking ibuprofen daily. When she returned to the doctor, surgery was mentioned as the next step. Sarah was hesitant about surgery after a friend told her horror stories of post-surgical foot pain. That’s when she found Unpain Clinic through our website and decided to give shockwave therapy a try as a last resort.
Initial Assessment: In Sarah’s first appointment (our one-hour Initial Assessment), we confirmed the Morton’s Neuroma diagnosis. We also discovered several contributing factors: her right ankle had limited mobility (likely from an old sprain years ago), and her calf muscles were extremely tight. We noted that when Sarah walked, she wasn’t pushing off the ground evenly – due to her stiff ankle, she was overloading the forefoot area where the neuroma pain was. Her footwear choices (narrow toe-box shoes for work) certainly didn’t help either. Sarah was relieved that someone was finally connecting these dots instead of just telling her to rest.
Treatment Plan: We created a plan focused on shockwave therapy plus addressing those root causes. We educated Sarah on changing her footwear (she switched to wider, cushioned sneakers for daily use and saved the heels for only special occasions). We started weekly shockwave therapy sessions. Each week, Uran applied focused shockwaves to the space between her 3rd and 4th metatarsals. The treatment was a bit intense – Sarah joked that it felt like a “jackhammer massage” – but she found it tolerable especially with the promise that it could heal her nerve pain. After each session, we did a few minutes of manual release on her foot and calf and guided her through a calf stretch and foot intrinsic exercises to do at home.
Progress: After the second shockwave session, Sarah noticed that her symptoms were changing. The constant burning had reduced to an occasional dull ache. By the fourth session, she could walk 18 holes on the golf course (with sneakers, not spikes) and finish with only mild discomfort, whereas previously she’d be in agony by the 9th hole. Her VAS pain score, which was 8/10 at baseline, came down to 3/10 after four treatments. Importantly, she reported that the weird “pebble in shoe” sensation was almost completely gone. We performed the Morton’s squeeze test (pressing the forefoot) and it was much less tender than before.
Sarah ended up having six shockwave sessions in total. At her final evaluation, she was essentially pain-free in day-to-day life – she could even wear her dress shoes for a couple of hours at a work function without trouble (though we encouraged her to stick mostly to her supportive shoes to prevent recurrence). With her neuroma pain calmed down, we transitioned her to a maintenance program of monthly check-ins, during which we’d give her calf/Achilles a tune-up and make sure her exercises were keeping her foot strong and flexible.
Outcome: Sarah avoided surgery and got her active life back. About three months after starting treatment, she sent us an update: “I walked all around Disneyland with my family – two days in a row, over 20,000 steps each day – and I had ZERO foot pain. I can’t remember the last time I could say that. Shockwave therapy was a game changer for me!”
Again, results like Sarah’s can’t be guaranteed for everyone, but her story shows that even if you’ve “tried everything,” there may still be a solution that works for you. Many patients with long-term neuroma pain have improved with a structured plan combining shockwave therapy and holistic care.
(Disclaimer: This example is for illustration only and not an actual patient endorsement. Individual experiences will vary. Always seek a personalized evaluation to see what’s appropriate for your condition.)
Managing Morton’s Neuroma isn’t just about in-clinic treatments – what you do between visits can make a big difference in your recovery. Here are some simple, at-home tips to support your healing (remember, these are general suggestions; always follow the specific advice given by your provider):
Footwear Choices: Switch to shoes that have a wide toe box and good arch support. Tight, narrow shoes or high heels compress the forefoot and can worsen neuroma pain. Look for comfortable sneakers or orthopedic shoes that reduce pressure on the ball of the foot. You may also use cushioned insoles or metatarsal pads (available at pharmacies) to help spread the metatarsal bones and take pressure off the nerve. If you’re unsure how to place a metatarsal pad, ask your physiotherapist or podiatrist to show you proper positioning.
Activity Modification: While you’re recovering, moderate your activities to avoid flaring up the nerve. This might mean temporarily cutting back on high-impact exercises (like running or jumping). Opt for lower-impact cardio such as cycling, swimming, or an elliptical machine – these let you stay active without pounding on your feet. When you do need to be on your feet for extended periods, try to take short breaks. For example, if your job involves lots of walking, sit down for a few minutes every hour to rest your feet.
Stretching and Mobility: Gentle stretches can help alleviate contributing factors. One crucial stretch is for your calf muscles (gastroc and soleus) – a tight calf can increase forefoot pressure. Do a calf stretch against the wall (both with knee straight and knee bent) for 30 seconds each, a few times a day. Also, practice toe stretches: using your hands, gently pull your toes apart (spread them) and hold for 15–20 seconds – this can relieve interdigital pressure. Picking up marbles or a towel with your toes is a great exercise to strengthen the foot’s intrinsic muscles and improve blood flow.
Pain Relief Measures: If your foot is achy at the end of the day, simple self-care can soothe it. Ice therapy can reduce nerve inflammation – roll your foot over a frozen water bottle or apply an ice pack to the painful area for about 10 minutes (not too long to avoid ice burn). Some people find contrast baths (alternating warm and cold water soaks) helpful to boost circulation. While over-the-counter anti-inflammatory gels or creams won’t fix the neuroma, rubbing a menthol-based gel (like Biofreeze) into the arch/forefoot can provide temporary comfort by dulling pain signals. Just avoid heavy, deep massage between the toes, as pressing directly on the neuroma might aggravate it.
Watch for Red Flags: Morton’s Neuroma is typically not dangerous, but you should know when to seek prompt medical attention. If you experience sudden severe foot pain that rapidly worsens, or if your toes develop significant numbness or discoloration, get evaluated sooner than later – especially if it’s a change from your usual symptoms. Also, if you ever notice signs of infection (for example, after an injection or if you have an ulcer on your foot) such as increasing redness, swelling, warmth, or fever, see a healthcare provider immediately. These situations are uncommon but important to rule out other issues.
Stay Consistent and Patient: At home, consistency is key. Doing your stretches and exercises daily, and wearing the right shoes, will complement the in-clinic treatments and speed up your progress. Be patient with yourself – nerve healing can be slower than, say, muscle healing. You might have good days and bad days, which is normal. Over several weeks, the good days should start to outnumber the bad. If you’re unsure about any home technique or if something you’re doing seems to cause more pain, pause and consult your therapist for guidance.
Disclaimer: The above tips are general educational suggestions for mild neuroma discomfort and post-treatment care. They are not a substitute for professional medical advice. Every individual’s condition is different – always follow the personalized recommendations given by your provider, and consult them if you have any questions or concerns about your at-home care.
Yes, shockwave therapy (ESWT) is generally considered safe for Morton’s Neuroma and other musculoskeletal issues when applied by a trained professional. It is non-invasive – no incisions, no injections – and thus avoids the risks associated with surgery. The side effects are typically minimal. Patients might experience transient soreness or mild bruising in the treated area. The discomfort during the treatment is manageable and short-lived. Serious adverse events are exceedingly rare; there have been no reports of shockwave causing nerve damage or other major injuries when proper protocols are followed. That said, there are a few contraindications to be aware of. Shockwave therapy should NOT be used over areas with active infection, open wounds, or malignancy (cancer). It’s also typically avoided in people with bleeding disorders or who are on heavy blood thinners, since the treatment can cause small blood vessel changes. We do not perform shockwave directly over pregnant women’s pelvis/abdomen (out of an abundance of caution). Overall, for a Morton’s Neuroma, ESWT is low-risk – far lower risk than surgery or long-term medication use. We will thoroughly assess your health history to ensure you’re a suitable candidate. Always ensure shockwave therapy is delivered by licensed providers with appropriate devices, as improper use could theoretically cause tissue irritation. At Unpain Clinic, patient safety is our top priority, and we adhere to evidence-based treatment parameters.
The number of sessions can vary, but most Morton’s Neuroma treatment protocols range from 3 to 6 shockwave therapy sessions, typically spaced about 1 week apart. In some cases, up to 8 sessions might be used for a very chronic condition, but that’s less common. Based on both research and our clinical experience, many patients start to notice improvement after the first 2–3 sessions (for example, a reduction in pain intensity or frequency). However, the maximum benefit of shockwave often isn’t apparent until several weeks after completing the full course. In the 2016 RCT, significant pain reduction was noted 4 weeks after treatment, suggesting that the healing processes stimulated by shockwave take a little time to unfold. In practice, we usually schedule, say, 4 sessions and then do a re-evaluation. If you’re, for instance, 80% better at that point, we might not need additional sessions – we’ll switch focus to rehab exercises and monitoring. If you’ve improved some but not fully, we might do a couple more sessions. The relief timeline also depends on how severe your neuroma was to start and how diligent you are with complementary measures (like wearing proper shoes and doing any prescribed exercises). Bottom line: Expect a series of treatments rather than an instant fix, with gradual improvement that can continue even 4-6 weeks after your last session as the nerve heals and inflammation subsides.
This is one of the most common questions, and understandably so! Shockwave therapy can cause some discomfort during the treatment, but it is generally tolerable. Patients often describe the sensation as a rapid tapping or thumping feeling. In the foot, where tissue is thinner, it can feel more intense (almost like a little jackhammer on the sole). The level of pain also depends on the chronic sensitivity of your tissue – an acutely inflamed neuroma area might be a bit tender when the shockwaves hit it. The good news is that the therapist can adjust the intensity and frequency of the shockwave device to match your comfort level. We usually start at a moderate setting and ask for your feedback, then gradually increase energy to a therapeutic level you can handle. Each pulse is very brief, and treatments are short, so any painful sensations don’t linger. Many patients find that after the first few hundred pulses, the area goes somewhat numb or they get used to it, and it actually feels less painful as the session goes on. After the session, you might have some soreness – akin to how one feels after a deep tissue massage – but this typically fades within 24 hours. No anesthesia or numbing medication is needed; you walk in and walk out under your own power. We’ve treated patients of all ages with shockwave – most are pleasantly surprised that it wasn’t as bad as they imagined. In summary: there can be mild pain during ESWT, but it is short-lived and considered well worth the trade-off for the healing benefit. We’ll work closely with you to keep you as comfortable as possible.
Yes, shockwave therapy can potentially help even chronic Morton’s Neuroma cases. In fact, many patients we see have had symptoms for multiple years – these are often the folks who are trying shockwave as a last resort before surgery, or even after other treatments failed. Research and clinical reports have included patients with neuroma pain lasting anywhere from a few months to several years. The healing mechanisms of shockwave (improving blood flow, stimulating nerve repair) can still be effective in long-standing conditions; it might just take a bit longer or require a few extra sessions compared to a more recent injury. If you’ve had the neuroma for years, there may be more fibrotic tissue built up, and your body likely fell into some compensatory movement patterns. We will address those alongside the shockwave therapy. Now, if you already had surgery (partial or full nerve removal) and are still having pain, that’s a trickier scenario. Sometimes post-surgical pain is due to a stump neuroma (a new neuroma forming at the cut end of the nerve) or scar tissue in the area. Shockwave therapy has been explored for treating painful stump neuromas – one study on amputation stump neuromas found ESWT yielded better pain reduction than conventional therapy. So, there is a rationale to use shockwave on a post-surgical neuroma as well, to try to break down scar tissue and modulate the new nerve pain. We would evaluate your specific situation; if your pain is truly coming from residual nerve/scar in the foot, a trial of shockwave might be considered even post-surgery. It’s important to have realistic expectations: a long-standing neuroma or a post-operative scenario can be complex, and results vary. But there is hope – we’ve seen “old” neuromas calm down with shockwave and good rehab, giving relief to people who thought they just had to live with it.
While shockwave therapy is safe for the vast majority of people, there are certain individuals who should avoid it or postpone it:
Pregnant women: We do not perform shockwave therapy over areas like the abdomen or low back in pregnancy, and generally we avoid treating pregnant patients with shockwave unless absolutely necessary, just out of caution (the effects on a fetus have not been studied). For foot pain in pregnancy, other modalities would be used instead.
People with bleeding disorders or on anticoagulant medication: ESWT can cause small blood vessel rupture and mild local bleeding; if you have hemophilia or are on high doses of blood thinners (like warfarin) that aren’t well-controlled, you could bruise more or in theory develop a hematoma. Your doctor would need to clear you, or we’d take special precautions/dosages.
Patients with peripheral neuropathy or loss of sensation in feet: If someone has another condition causing numbness in the feet (for example, diabetic neuropathy), we’d be cautious. The concern is they may not feel pain normally, so we wouldn’t be able to gauge their tolerance or response accurately. It doesn’t absolutely rule it out, but it requires careful use.
Areas with acute infection or wound: We would not apply shockwave over an infected foot ulcer or an open wound. The infection should be treated and cleared first.
Cancerous sites: Shockwave is not used over any known malignancy. If, hypothetically, a patient had a tumor in the foot (extremely rare scenario for this region), we would avoid it. This is a standard precaution for any therapy that increases blood flow.
Children (with caution): There isn’t much research on shockwave in very young patients. For adolescents with musculoskeletal issues, shockwave is occasionally used (for example, some cases of Osgood-Schlatter in teens), but for Morton’s Neuroma (which is rare in youth), it’s typically not relevant. If ever considered, it would be for skeletally mature teens and with guardian consent.
Severe circulation problems: If someone has peripheral arterial disease causing poor circulation in the feet, or severe uncontrolled diabetes with fragile tissues, we’d evaluate carefully. Shockwave does improve circulation, which is good, but in extreme cases (like critical ischemia) other interventions are priority.
For most typical Morton’s Neuroma patients, none of the above apply – so you’d likely be cleared for therapy. We always perform a thorough medical history intake to screen for any contraindications. If you’re unsure whether shockwave is appropriate for you due to a medical condition, just ask! We’ll give you guidance or coordinate with your physician to make sure it’s safe.
Coverage for shockwave therapy can vary widely depending on your location and insurance plan. Shockwave therapy is still relatively new in the realm of mainstream insurance coverage. In many regions, health insurance providers consider ESWT for musculoskeletal conditions to be an elective or adjunct treatment, and they may not reimburse it as a separate service. However, there are a few considerations:
If you are receiving shockwave therapy from a physiotherapist or chiropractor as part of a broader treatment session, the cost might be billed under general physiotherapy or chiropractic treatment codes. In such cases, your extended health benefits (if you have them) could cover a portion of the visit just like any other physio treatment. For example, at Unpain Clinic our sessions often include a combination of manual therapy, exercise therapy, and shockwave; we issue a receipt for physiotherapy or chiropractic treatment, which many patients can submit to their insurance.
Some insurance plans have started to recognize shockwave therapy for specific conditions. A few might cover ESWT for chronic plantar fasciitis or tennis elbow, for instance, after other treatments failed. Morton’s Neuroma is less commonly mentioned explicitly in coverage policies, but if a plan covers shockwave at all, it might apply here.
Provincial healthcare (in Canada) or Medicare (in the US) typically does not cover shockwave therapy for Morton’s Neuroma, as it’s considered an outpatient elective treatment. There are exceptions if it’s done in a hospital setting for certain indications, but foot neuromas wouldn’t likely qualify.
It’s always best to check with your insurance provider directly. Ask if “extracorporeal shockwave therapy” is covered under your plan, and if so, for what diagnoses and under what conditions (referral needed? Only after trying injection? etc.).
Even if not covered, many patients find the out-of-pocket cost worth it compared to the potential costs of surgery or ongoing symptom management. We also offer package pricing or payment plans at some clinics to make it more accessible. The Initial Assessment at Unpain Clinic (see our Enhanced CTA below) is typically covered as a standard physio or chiro exam by most insurance – during that visit, we can discuss the anticipated number of shockwave sessions and provide you with receipts you can submit to insurance for whatever portion is eligible.
In summary, insurance coverage for shockwave therapy is not guaranteed – it’s a good idea to verify your benefits. At Unpain Clinic, our administrative team can assist you in navigating your insurance questions, and we’re transparent about costs upfront so there are no surprises.
Side effects of shockwave therapy are generally minor and short-lived. The most commonly reported side effects include:
Local Pain or Discomfort: It’s normal to feel some soreness in the treated area for a day or two after a session. This is usually mild and can be managed with simple measures like ice or a mild analgesic if needed. It’s similar to post-massage soreness.
Redness or Mild Swelling: Right after treatment, the skin over the area might be a bit red or swollen from the increased blood flow and mechanical action. This typically resolves within hours.
Bruising: Because shockwaves can affect tiny blood vessels, occasional bruising can occur, especially in areas with less tissue padding (like the top of the foot). Bruises, if they happen, are usually small and fade in a week or so. We adjust intensity for patients who are prone to bruising.
Numbness or Tingling: Rarely, some patients report a slight numb or tingling feeling in the foot following treatment – this is usually transient and might be due to the nerve being stunned (in a sense, we want it to calm down!). It should return to normal shortly.
Temporary Symptom Flare: In a small number of cases, someone might feel a temporary increase in pain the evening or day after the first session – this can be part of the inflammatory healing response that shockwave triggers. It is usually followed by improvement thereafter. We mention this so you’re not alarmed if it happens; it’s typically not severe and goes away in a day or two.
No allergic reactions or systemic effects are expected, since nothing chemical is being applied – it’s just mechanical sound waves. This makes shockwave distinct from medications or injections where side effects can affect the whole body.
Skin Damage (Very Rare): If done improperly, there’s a hypothetical risk of blistering the skin or causing tissue damage, but this is exceedingly rare in experienced hands. We always ensure the ultrasound gel is applied (to transmit the sound waves) and keep the device moving as needed to avoid focusing too long on one exact spot at high power.
Overall, shockwave therapy’s side effect profile is extremely mild compared to most medical treatments – no incisions, no risk of infection, no anesthesia, and no need for downtime. Most people leave a session feeling fine, maybe slightly achy in the foot, but can resume normal light activities immediately. We consider that slight soreness a sign that the body’s healing response has been activated. Of course, if you ever have any concerns or unexpected symptoms after a treatment, you should contact your provider. But in our experience, adverse effects are minimal and transient. The vast majority of patients complete their shockwave course with nothing more than a bit of post-treatment tenderness and a good outcome to show for it.
Morton’s Neuroma may be a small problem (a tiny nerve in the foot) but it can have a huge impact on your quality of life. The persistent pain, tingling, and burning can make every step miserable. Traditionally, if rest, orthotics, and injections didn’t work, you might feel doomed to either live with the pain or face surgery. Now, shockwave therapy offers a compelling third option – a treatment that may help the nerve heal rather than removing it. While research is still ongoing, the evidence so far indicates that shockwave therapy can reduce Morton’s Neuroma pain and improve foot function for many patients. It’s a therapy that harnesses your body’s own healing abilities, with the bonus of being non-invasive and low-risk.
Not everyone with a neuroma will be a candidate for or respond to shockwave, and it’s important to have a thorough assessment to ensure it’s right for you. But if you’re someone who has been frustrated by chronic forefoot pain and you’re seeking a solution that doesn’t involve needles or scalpels, shockwave therapy for Morton’s Neuroma is certainly worth discussing with a knowledgeable clinician. Ideal candidates are often those with chronic (3+ months) neuroma symptoms who haven’t found relief through conventional means, or those looking to avoid or postpone surgery. It can also be used alongside other treatments like physiotherapy exercises and proper footwear to maximize the benefit.
At Unpain Clinic, we have made shockwave therapy a cornerstone of our approach because we’ve seen how powerful it can be in restoring patients’ mobility and comfort. We combine it with a whole-body perspective – because often, solving the pain involves addressing more than just the pain spot. If you’re tired of the cycle of “try everything, feel nothing,” and you’re ready to tackle not only where it hurts but why it hurts, our team is here to help. Relief from Morton’s Neuroma is possible, and it might be closer than you think with the right treatment plan.
Are you ready to take the next step towards pain-free feet? The first step is an assessment – and we promise, we’ll listen and make a plan that makes sense for you. Pain relief is the goal, but understanding the cause is the key. Let us help you get back on your feet with a solution that fits your needs.
Book Your Initial Assessment NowAt Unpain Clinic, we don’t just ask “Where does it hurt?” — we uncover “Why does it hurt?”
If you’ve been frustrated by the cycle of “try everything, feel nothing,” this assessment is for you. We take a whole-body approach so you leave with clarity, not more questions.
✅ What’s Included
Comprehensive history & goal setting
Orthopedic & muscle testing (head-to-toe)
Motion analysis
Imaging decisions (if needed)
Pain pattern mapping
Personalized treatment roadmap
Benefit guidance
🕑 Important Details
60 minutes, assessment only
No treatment in this visit
👩⚕️ Who You’ll See
A licensed Registered Physiotherapist or Chiropractor
🔜 What Happens Next
If you’re a fit, we schedule your first treatment and start executing your plan.
🌟 Why Choose Unpain Clinic
Whole-body assessment, not symptom-chasing
Root-cause focus, not temporary relief
Non-invasive where possible
No long-term upsells — just honest, effective care
🎯 Outcome
You’ll walk out knowing:
What’s wrong
Why it hurts
The fastest path to fix it
Author: Uran Berisha, BSc PT, RMT, Shockwave Expert
1. Seok H. et al. (2016). Extracorporeal Shockwave Therapy in Patients with Morton’s Neuroma: A Randomized, Placebo-Controlled Trial. J Am Podiatr Med Assoc, 106(2):93–99. pubmed.ncbi.nlm.nih.govshockwavecanada.com
2. Thomson L. et al. (2020). Non-surgical treatments for Morton’s neuroma: A systematic review. Foot Ankle Surg, 26(7):736–743. sciencedirect.comsciencedirect.com
3. Fridman R. et al. (2009). Extracorporeal shockwave therapy for interdigital neuroma. J Am Podiatr Med Assoc, 99(3):191–193. pure.psu.edupure.psu.edu
4. Meyer B., Moya D. (2022). Treatment of Morton’s neuroma with focused shock waves vs. surgery: A prospective study. J. of Regenerative Science, 2(2):13–16. jrsonweb.com
5. Cleveland Clinic (2023). Morton’s Neuroma – Causes, Symptoms & Treatment. my.clevelandclinic.orgmy.clevelandclinic.org
6. Shockwave Canada (2022). Morton’s Neuroma Treatment with Shockwave Therapy. shockwavecanada.comshockwavecanada.com
7. Unpain Clinic – Podcast Episode: Understand and Fix Your Chronic Foot Pain (June 18, 2021). unpainclinic.comunpainclinic.com
8. Unpain Clinic – Podcast Episode: Eliminate the cause of your knee pain with True Shockwave Therapy (Episode #5). unpainclinic.com
9.Unpain Clinic – Blog: Metatarsalgia: Understanding the “Ball-of-Foot” Pain… (Oct 15, 2025). unpainclinic.com
10. Matthews B.G. et al. (2019). Effectiveness of non-surgical interventions for Morton’s neuroma: a systematic review and meta-analysis. J Foot Ankle Res, 12:12. pubmed.ncbi.nlm.nih.gov (Pain outcomes of ESWT vs control)
11. CFOX DPM. Morton’s Neuroma – Shockwave Therapy Treatment. (Dr. C. Fox, Long Island Podiatry) shockwavecanada.com (Mechanism: desensitize nerve, improve blood flow)
12. Dellon A.L. (2017). Treatment of recurrent neuroma pain in the foot with relocated end-neuromata resection and muscle implantation. J Foot Ankle Surg, 56(2):287–93. (General reference on stump neuroma and pain – context for ESWT use)pmc.ncbi.nlm.nih.gov
