The Morton’s or intermetatarsal neuroma is a pinching of the nerve, most often between the 3rd and 4th metatarsal heads in the foot. It's due to a fibrosis close to the nerve tissue, but it does get termed a ‘neuroma’ even though it is not really a neuroma. It is more common in females in their fourth to six decades, indicating that tighter footwear might be part of the problem.
The key symptoms are usually shooting pains to the toes that gradually becomes worse, however it is not at all times a shooting kind of pain at first. Signs can vary from one individual to another with some just experiencing a numbness of the toe, and some just a mild prickling to burning type pains. Later there is usually an excruciating pain that may be there much of the time. Most commonly it is between the 3rd and 4th metatarsal heads, but sometimes occur between any of them. Compressing the ball of the foot from the sides can frequently produce the discomfort and frequently a click can be palpated with the finger of the other hand while compressing the foot. This is whats called a Mulder’s click.
What's causing it is presumed to be an compression on the nerve by the adjacent metatarsal head, creating a ‘pinched nerve’; the most obvious being wearing shoes which might be too tight round the ball of the feet. Also abnormal movement of the metatarsal heads could also be an issue, especially during sporting activity. Being overweight is also a common finding in those with a Mortons Neuroma.
Traditional treatment usually starts with advice on the correct fitting of footwear and the use of metatarsal pads or domes. The shoes needs to be wide enough to prevent the compression of the metatarsal heads and if possible have a lower heel height. If that is not useful, then a surgical excision of the neuroma is advised. From time to time the Mortons neuroma is treated with injections to try and dissolve the neuroma and cryosurgery is also sometimes tried.