A Mortons Neuroma is a pinching of the nerve, generally involving the 3rd and 4th metatarsal heads in the foot. It is due to a fibrosis surrounding the nerve tissue, but it does get named a ‘neuroma’ even though it is not truly a neuroma. It's in females in their forties to sixties, suggesting that smaller shoes could be part of the condition.
The key signs are shooting pains into the toes which gradually becomes worse, yet it is not necessarily a shooting type of pain initially. Signs may differ from one individual to another with some just having a numb feeling in the forefoot, and some simply a slight pins and needles to burning like pains. Later on there is generally an excruciating pain that may be present quite often. Most commonly it is between the 3rd and 4th metatarsal heads, but can occur in between any of them. Compressing the ball of the foot from the sides might produce the symptom and quite often a click can be felt with the finger of the other hand while compressing the foot. This is whats called a Mulder’s click.
The main cause is presumed to be an impingement on the nerve by the adjoining metatarsal head, creating a ‘pinched nerve’; the most apparent being wearing shoes that are too restricted across the ball of the feet. Also excessive motion of the metatarsal heads may be an issue, particularly during sporting exercise. Being overweight is also a frequent finding in people that have a Morton’s neuroma.
Conservative treatment typically begins with advice on the correct fitting of shoes and the use of metatarsal pads or domes. The footwear needs to be wide enough to prevent the pinching of the metatarsal heads and preferably have a reduced heel height. If that's not really useful, then a surgical removal of the neuroma is recommended. Occasionally the Mortons neuroma is treated with injection therapy in an attempt to dissolve the neuroma and cryosurgery can also be sometimes tried.