The Morton’s or intermetatarsal neuroma is a pinching of the nerve, usually between the 3rd and 4th metatarsal heads in the foot. It's due to a fibrosis around the nerve, but it does get named a ‘neuroma’ even though it is not actually a neuroma. It is in females in their forties to sixties, suggesting that more restrictive footwear could possibly be part of the problem.

The main signs are shooting pains into the toes which progressively becomes worse, however it is not necessarily a shooting sort of pain at first. Symptoms can vary from person to person with some only experiencing a numbness of the forefoot, and many just a moderate prickling to burning like pains. Later on there is generally an excruciating pain that could be there much of the time. It usually is between the 3rd and 4th metatarsal heads, but they can occur in between any of them. Squeezing the ball of the foot from the sides will often produce the pain and frequently a click can be palpated with the finger of the other hand while squeezing the ball of the foot. This is called a Mulder’s click.

What's causing it is presumed to be an impingement on the nerve by the adjoining metatarsal head, resulting in a ‘pinched nerve’; the most apparent being using footwear which are too restricted round the ball of the feet. Additionally too much motion of the metatarsal heads could also be an issue, especially during sporting activity. Being overweight is also a frequent finding in individuals with a Morton’s neuroma.

Conservative treatment generally starts with advice on the right fitting of shoes and the use of metatarsal pads or domes. The shoes needs to be wide enough to stop the compression of the metatarsal heads and if possible have a reduced heel height. If that is not really useful, then a surgical removing of the neuroma is warranted. Occasionally the Mortons Neuroma is treated with injections to try and break down the neuroma and cryosurgery may also be occasionally used.

What is the typical symptom of a Morton’s neuroma?
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