A Morton’s or intermetatarsal neuroma is a pinching of the nerve, generally between the 3rd and 4th metatarsal heads in the foot. It is as a result of fibrosis close to the nerve, however it does get called a ‘neuroma’ even though it is not truly a neuroma. It's in females in their 40's to 60's, implying that smaller shoes could possibly be part of the issue.
The main signs usually are shooting pains to the toes that gradually gets worse, however it is not at all times a shooting type of pain in the beginning. Symptoms will vary from one person to another with a few just experiencing a tingling of the forefoot, and some just a mild pins and needles to burning like pains. Subsequently there is usually an excruciating pain that can be present much of the time. It usually is between the 3rd and 4th metatarsal heads, but could occur in between any of them. Compressing the ball of the foot from the sides might produce the symptom and sometimes a click is often felt using the finger of the other hand while compressing the foot. This is known as a Mulder’s click.
The cause is suspected to be an impingement on the nerve by the adjacent metatarsal head, setting up a ‘pinched nerve’; the most apparent being wearing shoes that are too restricted over the ball of the feet. Additionally too much movement of the metatarsal heads could also be a factor, especially during athletic exercise. Obesity is also a common finding in people that have a Morton’s neuroma.
Traditional treatment typically begins with advice on the correct fitting of shoes and the use of metatarsal pads or domes. The footwear has to be wide enough to prevent the compression of the metatarsal heads and if possible have a reduced heel height. If that's not useful, then a surgical removal of the neuroma is warranted. Occasionally the Mortons Neuroma is treated with injection therapy in an attempt to dissolve the neuroma and cryosurgery may also be sometimes used.