Description

Morton’s Neuroma is named for the doctor (Dr. Thomas Morton) who first identified forefoot pain in the third interspace between third and fourth toes as an abnormal but benign growth/enlargement of nerve cells resulting from irritation of branches of the medial and lateral plantar nerves as they cross between the metatarsal bones. Neuromas in the foot can also develop in the first, second and fourth interspaces, though these are less common. The irritation is caused by faulty biomechanics of the foot, the wearing of improperly fitting tight shoes, by swelling of the foot or by abnormal bony structures or growths in the forefoot. Doctors or Footcare Specialists can confirm the presence of a neuroma by using the Mulder’s Sign test which involves placing the thumb under the painful interspace while the metatarsal heads are squeezed together with the other hand. The confirming positive sign is a loud popping or clicking sound and pain. Morton’s neuroma is a condition that affects more women than men.

Symptoms

Pain in the affected forefoot is the usual complaint. There may also be numbness and tingling in the adjacent toes, a feeling of walking on a marble or a bunched sock, the sensation of walking on razor blades, a burning sensation or a popping, dislocating or spasming sensation. Rubbing the area provides minor relief and may produce a clicking sensation.

Pedorthic Management

• Custom made foot orthotics – help to provide proper support and alignment to the foot, controlling conditions such as over pronation.
• Metatarsal pads (metatarsal support) – Widen the space between the third and forth metatarsal bones and increase the area in the third interspace. The metatarsal pad should be placed either intrinsically into the custom orthotic or extrinsically inside the shoe on the insole proximal to the metatarsal head, under the affected interspace.
• Orthopedic Footwear – Properly fitted (length and width) that do not cause squeezing or cramping of the toes or force the forefoot to accommodate much of the body’s weight during walking or running (as with high heeled shoes).

Other Treatments/Modalities

• Cortisone and/or Lidocaine injections
• Cryosurgical ablation
• In severe cases surgery