The Morton’s or intermetatarsal neuroma is an impingement of the nerve, most often between the 3rd and 4th metatarsal heads. It's as a result of fibrosis around the nerve, however it does get named a ‘neuroma’ even though it is not actually a neuroma. It's in females in their forties to sixties, suggesting that smaller shoes may be part of the problem.
The primary symptoms are usually shooting pains into the toes which gradually becomes worse, however it is not at all times a shooting sort of pain to start with. Signs will vary from one individual to another with some just experiencing a pins and needles of the toe, and many just a mild tingling to burning type pains. Later on there is usually an excruciating pain that may be present much of the time. Most commonly it is between the 3rd and 4th metatarsal heads, but can be seen in between any of them. Compressing the ball of the foot from the sides can often produce the discomfort and frequently a click might be felt using the finger of the other hand while compressing the foot. This is called a Mulder’s click.
What causes it is suspected to be an compression on the nerve tissue by the adjoining metatarsal head, resulting in a ‘pinched nerve’; the most apparent being using shoes that are too tight across the ball of the feet. Additionally too much movement of the metatarsal heads could also be an issue, especially during athletic activity. Being overweight is also a common finding in people that have a Morton’s neuroma.
Conservative treatment typically begins with advice on the correct fitting of footwear and the use of metatarsal pads or domes. The footwear needs to be wide enough to stop the pinching of the metatarsal heads and preferably have a reduced heel height. If that is not really useful, then a surgical excision of the neuroma is indicated. Occasionally the Mortons Neuroma is helped by injections to try and break down the neuroma and cryosurgery can also be occasionally tried.