Morton's Neuroma


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

  • Definition
  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
  • Conservative therapy
  1. Often does not provide relief
  2. Pad to separate third and fourth Metatarsals heads
  3. Avoid tight fitting shoes
  4. Morton's Neuroma Injection
  • Management
  • Surgery
  1. Corticosteroid Injection
  2. Surgical Excision of Neuroma
    1. Indicated in failed conservative management