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