A 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, 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 footwear could be part of the cause.
The primary symptoms are usually shooting pains into the toes that gradually becomes worse, yet it is not at all times a shooting kind of pain to start with. Symptoms can differ from individual to individual with a few just experiencing a numbness in the toe, and many simply a slight pins and needles to burning like pains. Later on there is usually an excruciating pain which can be there most of the time. It usually is between the 3rd and 4th metatarsal heads, but they can be found between any of them. Compressing the ball of the foot from the sides might produce the symptom and frequently a click is often palpated with the finger of the other hand while squeezing the ball of the foot. This is called a Mulder’s click.
The main cause is suspected to be an compression on the neural tissue by the adjacent metatarsal head, creating a ‘pinched nerve’; the most obvious being wearing shoes that happen to be too tight over the ball of the foot. Additionally increased motion of the metatarsal heads may also be an issue, particularly during sporting exercise. Being overweight is also a frequent finding in those with a Morton’s neuroma.
Conservative treatment generally 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 reduced heel height. If that's not helpful, then a surgical removal of the neuroma is recommended. Sometimes the Mortons neuroma is helped by injection therapy to try and break down the neuroma and cryosurgery may also be sometimes tried.