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.

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

Foot diagnoses

Acute

• Foot and toe fractures
• Subtalar dislocation
• Metatarsophalangeal joint sprain (turf toe)
• Acute arterial ischemia
• Calcaneal bursitis

Subacute/Chronic

• Diabetic foot infection
• Peripheral artery disease
• Plantar fasciitis
• Trench foot
• Ingrown toenail
• Paronychia
• Tinea pedis
• Morton's neuroma
• Diabetic neuropathy

Evaluation

• Clinical diagnosis

Management

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

Disposition

• Discharge

References

https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/foot-and-ankle-disorders/interdigital-neuralgia