One of the most common nerve problems in the forefoot is known as Morton’s neuroma. This condition is a type of forefoot pain that is often described as burning, numbing or shooting. This occurs due to the presence of a neuritis or a neuroma.
A Morton’s neuroma occurs in between the metatarsal bones of the forefoot, due to chronic irritation and inflammation of one of the plantar digital nerves. This is a nerve entrapment due to foot structure, foot function (biomechanics) or abnormalities in the bone space, as there are nerves located between the metatarsal bones.
Pain located directly at the ball of the foot (around the metatarsal heads).
Callus or corns may be present at the base of the metatarsal head.
Radiating/shooting pain is experienced, or numbness with reduced sensation in the surrounding toes.
Pain is worsened with lateral squeeze of the metatarsal heads/ forefoot.
A painful “click” when metatarsals are squeezed together (Mulder’s Sign).
The presence of Morton’s neuroma is caused by overloading of the forefoot either through abnormal biomechanics, localized forefoot inflammation, laxity of forefoot ligaments, and sports participation (intensive or recreational). Typically, abnormal weight distribution across the metatarsal heads can lead to chronic irritation and inflammation of the periosteum and surrounding tissues.
Patients are often predisposed to neuroma problems if they have: hammertoe deformities, hallux abducto-valgus (bunion) leading to lesser metatarsal overload, hypermobility in the forefoot, Achilles tendon tightness, pronated or flat feet, certain high-arch (pes cavus) foot types, shorter first metatarsal bones or previous forefoot surgeries such as osteotomies.
1. Ultrasound therapy