The Mortons Neuroma is an impingement of the nerve, typically involving the 3rd and 4th metatarsal heads in the foot. It is because of a fibrosis close to the nerve tissue, but it does get called a ‘neuroma’ even though it is not really a neuroma. It is in females in their forties to sixties, implying that tighter footwear might be part of the issue.
The key symptoms are shooting pains into the toes which gradually becomes worse, however it is not at all times a shooting type of pain initially. Signs may differ from individual to individual with some just experiencing a tingling of the forefoot, and some simply a mild tingling to burning like pains. Subsequently there is usually an severe pain that can be present most of the time. It usually is between the 3rd and 4th metatarsal heads, but can be found in between any of them. Compressing the ball of the foot from the sides might produce the symptom and sometimes a click might be felt using the finger of the other hand while compressing the foot. This is whats called a Mulder’s click.
What's causing it is assumed to be an impingement on the nerve tissue by the adjacent metatarsal head, creating a ‘pinched nerve’; the most obvious being using footwear which might be too tight over the ball of the feet. Also increased movement of the metatarsal heads may be a factor, particularly during athletic exercise. Being overweight is also a common finding in individuals with a Morton’s neuroma.
Conservative treatment usually begins with advice on the correct fitting of footwear and the use of metatarsal pads or domes. The shoes has to be wide enough to prevent the pinching of the metatarsal heads and if possible have a lower heel height. If that's not necessarily helpful, then a surgical excision of the neuroma is indicated. From time to time the Mortons neuroma is helped by injections to try and dissolve the neuroma and cryosurgery may also be occasionally tried.