The Mortons Neuroma is an impingement of the nerve, typically involving the 3rd and 4th metatarsal heads in the foot. It's caused by a fibrosis close to the nerve, however it does get termed a ‘neuroma’ even though it is not really a neuroma. It's more prevalent in females in their forties to sixties, implying that tighter shoes may be part of the issue.
The main signs are usually shooting pains into the toes that progressively gets worse, however it is not at all times a shooting sort of pain to start with. Signs can differ from individual to individual with a few only having a pins and needles in the forefoot, and some simply a moderate prickling to burning like pains. Later there is generally an excruciating pain that may be present most of the time. Most commonly it is between the 3rd and 4th metatarsal heads, but they can be seen in between any of them. Squeezing the ball of the foot from the sides will often produce the discomfort and quite often a click may be palpated using the finger of the other hand while squeezing the ball of the foot. This is whats called a Mulder’s click.
The cause is assumed to be an compression on the neural tissue by the adjacent metatarsal head, setting up a ‘pinched nerve’; the most obvious being using shoes that are too tight over the ball of the feet. Also too much motion of the metatarsal heads may be an issue, especially during athletic activity. Obesity is also a common finding in those with a Morton’s neuroma.
Traditional treatment usually starts with advice on the correct fitting of shoes and the use of metatarsal pads or domes. The footwear has to be wide enough to stop the pinching of the metatarsal heads and preferably have a reduced heel height. If that is not necessarily useful, then a surgical removal of the neuroma is advised. Occasionally the Mortons neuroma is helped by injection therapy in an attempt to dissolve the neuroma and cryosurgery is also sometimes used.