Foot

Morton's Neuroma

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Morton's Neuroma, Morton Neuroma, Interdigital Neuroma, Morton's Metatarsalgia

  • Definitions
  1. Morton's Neuroma
    1. Perineural fibrosis of plantar nerve
    2. Affects medial and lateral plantar branch communication
  • Mechanism
  1. Repetitive Trauma
  2. Secondary Fibrosis
  3. Painful fusiform swelling of nerve
  • Epidemiology
  1. Women more often affected than Men
  • Symptoms
  1. Severe burning pain at third web space
  2. Numbness in affected toes
  3. Radiation of pain into third and fourth toes
  4. Provocative
    1. Worse with activity
    2. Aggravated by tight shoes
  5. Palliative
    1. Relieved by removing shoe
    2. Relieved by massaging foot
  • Signs
  1. Mulder Click Test
    1. Dorsiflex the foot
    2. Squeezing the Metatarsals results in a "clicking" sound in Morton's Neuroma
  • Differential Diagnosis
  1. Plantar Fasciitis (if affecting tibial nerve in proximal foot)
  • Management
  1. Conservative therapy
    1. Often does not provide relief
    2. Footwear alteration (flat shoes to reduce pressure on Metatarsal heads)
    3. Metatarsal pad
    4. Pad to separate third and fourth Metatarsals heads
    5. Avoid tight fitting shoes
  2. Morton's Neuroma Injection
    1. Better efficacy under Ultrasound guidance
    2. Anesthetic alone is as effective as if combined with coticosteroid
      1. Anesthetic alone injections also avoids adverse effects (soft tissue atrophy)
  3. Surgery
    1. Indicated in failed conservative management
    2. Techniques (all with equivalent efficacy based on 2024 cochrane review)
      1. Nerve decompression
      2. Cryogenic neuroablation
      3. Surgical Excision of Neuroma
  • References
  1. Matthews (2024) Cochrane Database Syst Rev 2(2):CD014687 +PMID: 38334217 [PubMed]