Morton's neuroma

Background

Morton's neuroma anatomy

• AKA interdigital neuralgia
• Morton's neuroma describes benign enlargement of perineurium (neuroma) along the sensory nerves of the toes.

Interdigital nerve irritation (neuralgia) or persistent benign enlargement of the perineurium (neuroma) can cause pain, which may be nonspecific, burning, or lancinating, or a foreign body sensation. Diagnosis is usually clinical. Treatment may involve correction of footwear, local injection, or sometimes surgical excision.

Clinical Features

Dorsal Morton's neuroma

• Pain, often nonspecific, burning, or lancinating, around metatarsal heads or toes
• Usually unilateral
• Worse with narrow/closed toe shoes
• May have foreign body sensation like a pebble in their shoe
• Tenderness to palpation on plantar aspect of interdigital space with reproduction of burning pain
  • Squeezing interdigital space may produce notable click

Differential Diagnosis

• Metatarsalgia
• Toe phalanx fracture
• Diabetic neuropathy
• Baxter's neuropathy
• Tarsal tunnel syndrome

Evaluation

• Clinical diagnosis

Management

• Outpatient management may include corrective footwear, local steroid/anesthetic injection, surgical excision

Disposition

• Discharge