The Mortons or intermetatarsal neuroma is an impingement of the nerve, usually between the 3rd and 4th metatarsal heads. It's because of a fibrosis around the nerve tissue, but it does get termed a ‘neuroma’ even though it is not actually a neuroma. It's more common in females in their forties to sixties, suggesting that more restrictive footwear could possibly be part of the issue.
The primary signs are shooting pains into the toes that progressively gets worse, however it is not always a shooting kind of pain to start with. Signs may differ from one person to another with some just experiencing a tingling of the forefoot, and many simply a slight tingling to burning type pains. Later on there is often an severe pain which can be present much of the time. It usually 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 discomfort and often a click may be felt with the finger of the other hand while compressing the ball of the foot. This is whats called a Mulder’s click.
The cause is suspected to be an impingement on the nerve tissue by the adjacent metatarsal head, setting up a ‘pinched nerve’; the most obvious being using footwear that happen to be too tight round the ball of the feet. Also excessive movement of the metatarsal heads may also be a factor, particularly during sporting exercise. Being overweight is also a common finding in people that have a Morton’s Neuroma.
Traditional treatment generally begins with advice on the correct fitting of shoes and the use of metatarsal pads or domes. The shoes needs to be wide enough to stop the compression of the metatarsal heads and if possible have a lower heel height. If that is not helpful, then a surgical excision of the neuroma is advised. From time to time the Mortons neuroma is helped by injection therapy to try and break down the neuroma and cryosurgery is also sometimes tried.