Introduction
An Intermetatarsal (Mortons) Neuroma is a thickening of nerve sheath/tissue located between the metatarsal bones of the foot. Most commonly located between the 3rd and 4th interspace as this is where the Medial and Lateral Plantar Nerves combine making it an already larger nerve. This location is known as Mortons Neuroma.
Etiology
Causes of developing an Intermetatarsal Neuroma include:
• Compression and irritation of the nerve
• Ill fitting footwear – Shoes that are too small, have a tight/narrow toe box or high heel shoes that increase pressure onto the metatarsal heads
• Foot deformities – Bunions, flat feet, over pronation, hammer digits, collapsed transverse arches will all increase the susceptibility of compression to the nerve sheath and thus may develop a neuroma.
• Sporting Activities – Sports such as; running, tennis, ballet and Irish dancing require extra load/time on the ball’s of the feet
Symptoms
• Localized pain intermetatarsally that can be sharp or dull
• Tingling, burning or numbness may be present
• Symptoms can radiate along the foot distally or/and proximally
• The associated digits may be numb
• Pain usually increases with wearing footwear
• Pain can increase with palpation of the metatarsal interspace
• Pain can increase with testing “Mulders Sign” and a ‘click’ may be heard
How a Podiatrist can help?
• Diagnosing and treating any occurring foot deformities with orthoses devices
• Pain can increase with testing “Mulders Sign” and a ‘click’ may be heard
• Applying a metatarsal arch pad to footwear to reduce the compression forces on the nerve
• Advising activity modification – Rest and icing the area
• Non Steroidal Anti-inflammatory drugs can help minimise pain and inflammation
• Footwear advise – wear shoes with wide toe boxes and avoid high heel or narrow shoes
• An X-ray may need to be taken to rule out differential diagnosis such as stress fractures
• Doctor or Orthopaedic referral for corticosteroid injection or reconstructing bone alignment through surgery
