A Morton’s or intermetatarsal neuroma is a pinching of the nerve, most often between the 3rd and 4th metatarsal heads. It is due to a fibrosis around the nerve tissue, in this case it does get called 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 may be part of the problem.

The main symptoms are shooting pains into the toes that progressively gets worse, however it is not always a shooting type of pain initially. Symptoms can vary from person to person with some only experiencing a numbness of the toe, and some just a mild tingling to burning like pains. Later there is often an excruciating pain that can be present most of the time. Most commonly it is between the 3rd and 4th metatarsal heads, but can occur between any of them. Squeezing the ball of the foot from the sides can often produce the pain and sometimes a click can be felt with the finger of the other hand while squeezing the foot. This is called a Mulder’s click.

The cause is assumed to be an impingement on the nerve by the adjacent metatarsal head, creating a ‘pinched nerve’; the most obvious being wearing shoes that are too tight across the ball of the foot. Also excessive movement of the metatarsal heads could also be a factor, especially during sporting activity. Obesity is also a common finding in those with a Morton’s neuroma.

Conservative treatment usually starts with advice on the correct fitting of footwear and the use of metatarsal pads or domes. The footwear needs to be wide enough to prevent the pinching of the metatarsal heads and preferably have a lower heel height. If that is not helpful, then a surgical removal of the neuroma is indicated. Sometimes the Mortons neuroma is treated with injections to try and dissolve the neuroma and cryosurgery is also sometimes used.