Morton Neuroma

Morton neuroma also known as an intermetatarsal neuroma; is a painful condition that affects your forefoot in particular between your third and fourth toe. It is diagnosed more frequently in females than males and has a high incident rate in the 40-55 year-old age bracket.

A neuroma is whereby the nerve increases in thickness as a result of compression and irritation of the nerve. The increase in thickness occurs within the sheath surrounding the nerve.

Symptoms

Typically, there are no visual cues to suggest a neuroma is present, however you may present with one or more of these symptoms: 

  • Pins and needles in the forefoot.

  • Shooting pain from your forefoot up towards your ankle.

  • Burning pain that radiates towards the toes. 

  • A sensation that you are walking on a pebble or your socks are bunched up underneath your forefoot.

Cause

Tissue overload is the fundamental reason for the buildup of scar tissue and inflammation. There are numerous extrinsic and intrinsic reasons why this tissue overload occurs biomechanically.  

  • The most common cause is high- heeled shoes or tapered forefoot shoes which force the toes into the narrow toe-box. 

  • Repetitive activities such as running, jumping, dancing and court sports.

  • Activities with tight fitting shoes such as skiing, rock climbing and snorkelling.

  • Forefoot deformities- hallux valgus (Bunions), hallux limitus/rigidus and toe misalignments (hammer, claw, and mallet toes). 

  • Flat feet ( Pes planus) or high arch ( Pes cavus) foot type.

  • Excessive forefoot flexibility.

Diagnosing

A simple squeeze test of the forefoot can return a positive mulder’s sign producing a clicking sound or sensation. A secondarily thumb and index squeeze test will be performed to confirm location. Imaging is often used as well to rule out any differential diagnoses such as, intermetatarsal bursitis, plantar plate rupture, metatarsalgia or metatarsophalangeal joint capsulitis.

Treatment

Initially treatment will focus on pain reduction and reduction of tissue stress. This can be achieved through an initial extracorporeal shockwave therapy treatment in conjunction with padding or unloading taping techniques. A gait assessment will be done to assess for any abnormal biomechanical issues which could be contributing to the irritation of the nerve; depending on the results prefab or custom foot orthotics may be recommended to offload the irritated nerve.  

Very rarely if all conservative treatments have been exhausted The Feet Group will refer you for an ultrasound guided cortisone injection or a surgeon for a neuroma excision.