Morton's neuroma

Morton's neuroma is a common condition that causes pain often described as "electric" or particularly debilitating when walking.

1. What exactly is it?

It is a compression of a common plantar nerve, most often in the 3rd intermetatarsal space (between the 3rd and 4th toes). When repeatedly compressed or irritated by the metatarsal heads, the nerve becomes inflamed and is surrounded by fibrous tissue, forming a kind of "lump" or spindle.

2. Why does it happen?

Several factors can contribute to the development of this condition:

• Footwear: This is the #1 factor. Shoes that are too narrow or have high heels compress the forefoot and increase pressure on the nerves.
• Foot anatomy: Flat feet or very high arches can alter load distribution.
• Sports activity: Sports with repeated impacts (running) or compression (cycling) worsen symptoms.

3. Characteristic symptoms

The pain is very specific to Morton's neuroma:

• Burning sensation or electric shock under the forefoot.
• Feeling like there's a "pebble in the shoe" or a bunched-up sock.
• Pain exacerbated by walking and relieved by taking off shoes (an urgent need to remove shoes and massage the foot).
• Numbness (paresthesia) of the affected toes.

4. Diagnosis and Treatment

A doctor can diagnose the neuroma by palpation: pressure between the metatarsals often triggers the pain (Mulder's click sign). An ultrasound or MRI usually confirms the size of the neuroma.

Therapeutic options:

1. Footwear: Switch to wide, flat shoes to provide more space.
2. Orthotic insoles: These help spread the metatarsal heads to relieve nerve compression.
3. Injections: Corticosteroid injections to reduce nerve inflammation.
4. Surgery: As a last resort, the neuroma is removed (neurectomy) or the space is freed up (neurolysis).

Note: This condition predominantly affects women (about 4 out of 5 cases), often due to the type of footwear worn throughout life.