Morton's Neuroma (inter-digital neuralgia) is a medical disorder which causes pain in the forefoot especially in between the digits.A neuroma is a benign tumor of a nerve.Morton's neuroma is not exactly a tumor, but a thickening of the tissue that covers the digital nerve leading to the toes.Morton neuroma is damage to the nerve between the toes, which induces thickening and pain.It most often involves the nerve between the third and fourth metatarsal bones, producing pain and numbness in the third and fourth toes.It can also involve the nerve between the second and third metatarsal bones, producing symptoms in the second and third toes.Morton's neuroma seldom involves the nerve between the first and second, or between the fourth and fifth, metatarsal bones.The cause is due to perineural fibrosis of the planter nerve where the medial and lateral planter branches of the nerve join.The fibrosis is probably due to repeated injury of the nerve resulting in a painful fusiform swelling of the nerve.Morton's neuroma happens as the nerve passes under the ligament joining the toe bones (metatarsals) in the forefoot.The incidence of Morton's neuroma is 8 to 10 times higher in women than in men.Females are normally involved because of the shoe wear. (High heel tight shoes)The following may play a part in the formation of this disorder:1. Wearing tight shoes and high heels2. Abnormal positioning of toes3. Flat feet4. Forefoot problems, including bunions and hammer toes4. High foot archesMorton Neuroma is thought to form as a result of long-standing (chronic) stress and irritation of a plantar digital nerve.1. Some thickening (fibrosis) and swelling may then develop around a part of the nerve.2. This can look like a neuroma and can lead to compression of the nerve.Symptoms:If the patient sometimes senses that he or she is "walking on a marble," the patient may have Morton's neuroma1. Severe burning pain in the region of the third web2. Pain may spread to the third and fourth toes3. Pain is exacerbated by tight shoesDiagnosis:1. During the examination, the doctor will feel for a palpable mass or a "click" sound between the bones.2. He or she will put pressure on the spaces between the toe bones to try to induce the pain and look for calluses or proof of stress fractures in the bones that might be the source of the pain.There is tenderness on digital pressure between the third and fourth metatarsal headsCompression of the forefoot transversely also produce the same pain3. The range of motion tests will exclude arthritis or joint inflammations.4. X-rays may be needed to exclude a stress fracture or joint arthritis that joins the toes to foot5. MRI or ultrasound can successfully detect the conditionTreatment:1 Surgical removal of neuroma or decompression of the nerve is often essential.2. Local injection of lignocaine and steroid may relieve the pain.3. Tight fitting shoes should be avoidedThe doctor may advise any of:1. Padding and taping the toe area2. Shoe inserts or orthoses3. Changes to footwear, such as wearing shoes with wider toe boxes or flat heels4. Anti-inflammatory medicines taken by mouth or injected into the toe area5. Nerve blocking medicines injected into the toe area6. Other painkillers7. Physical therapy8. Anti-inflammatories and painkillers are not advised for long-term treatment.9. In some patients, surgery is needed to remove the thickened tissue and inflamed nerve.This helps alleviate pain and improve foot function.10. Numbness after surgery is permanent.11. Cryotherapy may helpTABLE OF CONTENTIntroductionChapter 1 Morton NeuromaChapter 2 CausesChapter 3 SymptomsChapter 4 DiagnosisChapter 5 TreatmentChapter 6 PrognosisChapter 7 Hallux ValgusChapter 8 Hammer ToesEpilogue