A Mortons neuroma is a pinched nerve between the metatarsal heads in the foot

A Morton’s or intermetatarsal neuroma is an impingement of the nerve, usually involving the 3rd and 4th metatarsal heads in the foot. It is caused by a fibrosis close to the nerve, but it does get termed a ‘neuroma’ even though it is not truly a neuroma. It's in females in their 40's to 60's, implying that tighter footwear might be part of the problem.

The main symptoms are usually shooting pains into the toes that gradually becomes worse, however it is not at all times a shooting type of pain in the beginning. Symptoms may differ from person to person with a few only having a pins and needles in the forefoot, and many just a mild pins and needles to burning type pains. Later on there is usually an excruciating pain that may be present much of the time. Most commonly it is between the 3rd and 4th metatarsal heads, but could be found in between any of them. Squeezing the ball of the foot from the sides may produce the discomfort and sometimes a click may be felt using the finger of the other hand while compressing the ball of the foot. This is known as a Mulder’s click.

What's causing it is assumed to be an impingement on the nerve tissue by the adjacent metatarsal head, setting up a ‘pinched nerve’; the most apparent being wearing shoes that happen to be too tight across the ball of the feet. Additionally increased motion of the metatarsal heads may also be an issue, especially during sporting exercise. Being overweight is also a frequent finding in people that have a Morton’s neuroma.

Conservative treatment typically starts with advice on the right fitting of shoes and the use of metatarsal pads or domes. The shoes has to be wide enough to prevent the pinching of the metatarsal heads and preferably have a lower heel height. If that's not really helpful, then a surgical excision of the neuroma is warranted. Sometimes the Mortons Neuroma is helped by injection therapy to try and break down the neuroma and cryosurgery is also sometimes used.

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