Morton’s Neuroma

Author: Anushka Pradhan

Editor: Nicholas Jo

 

Overview 

Morton’s Neuroma is neuropathic pain in the forefoot and is related to the interdigital nerve (Gougoulias, 2019). It commonly occurs between the second and third metatarsals (Zabaglo, 2020). It is associated with pressure distribution changes in the foot due to either a deformity or calf muscle tightness (Gougoulias, 2019).

 

Keywords

Morton’s Neuroma, Intermetatarsal Neuroma

 

Epidemiology

This condition frequently presents among middle-aged women. It is five times more common in females than in males (Munir, 2020).

 

Etiology 

Morton’s Neuroma commonly occurs at the third interspace because it is relatively narrow (Munir, 2020). The interdigital nerve to the third space receives branches from medial and lateral plantar nerves and has increased thickness making it more prone to compression and trauma (Munir, 2020). The compression of the interdigital nerve against the distal end of the transverse metatarsal ligament can occur as a result of narrow footwear, hyperextension of the toes in high-heeled shoes, deviation of the toes, inflammation of the intermetatarsal bursa, or as a result of other factors (Munir, 2020).

 

Symptoms 

The most common symptoms of Morton’s Neuroma include the following:

  • Burning, stabbing, or tingling sensations at the bottom of the foot,
  • Numbness between the toes,
  • Pain at the bottom of the foot is aggravated by walking and wearing tight-fitting, high-heeled shoes and relieved by resting and removing shoes,
  • Pain in hindfoot or cramping legs with prolonged walking, 
  • Sensation of walking on a stone or marble (Munir, 2020).

 

Risk Factors 

Risk factors include trauma from a crush or penetrating injury to the foot, thickened transverse metatarsal ligament, enlarged bursa in the interspace, and repetitive trauma from running (Munir, 2020).

 

Diagnosis 

Clinical Features

A thorough history and clinical examination are encouraged (Munir, 2020). During a physical exam, compressing the forefoot in the mediolateral direction while palpating the affected space can result in a crunching or clicking feeling and reproduction of symptoms (Munir, 2020). Weight-bearing radiographs, ultrasound scans or MRI can help rule out a differential diagnosis (Munir, 2020). 

Pathological Features

The MRI imaging or sonographic evaluation would likely demonstrate a dumbbell-shaped soft tissue lesion within the intermetatarsal space (Munir, 2020). Additionally, the T1 signal is often low, and the T2 signal frequently low or intermediate (Munir, 2020). 

 

Treatment Protocol

Pharmacological Treatment

It is recommended that initial treatment is nonoperative (Gougoulias, 2019). Anti-inflammatory medications, tricyclic antidepressants such as amitriptyline, and anti-seizure medications such as gabapentin can potentially lessen the severity of symptoms (Munir, 2020). Ultrasound-guided steroid injections or alcohol nerve injections may help short-term (Munir, 2020). 

 Non-Pharmacological Treatment

This may include recommended physiotherapy, less strenuous physical activities, use of wide-fitting footwear, cryotherapy, radiofrequency ablation, and shockwave therapy (Gougoulias, 2019). Morton’s Neuroma can also be removed surgically via a dorsal or plantar approach (Munir, 2020). 

 

Articles on Misdiagnosis

Chaganti, S., Joshy, S., Hariharan, K., & M. Rashid. (2013). Rheumatoid nodule presenting as Morton’s neuroma. Journal of Orthopaedics and Traumatology, 14(3), 219-222. DOI: 10.1007/s10195-012-0215-x. 

Davies, M.S. (2018). Failed Morton’s neuroma surgery. Orthopaedic Proceedings, 94-B, 2049-4416. Retrieved from https://online.boneandjoint.org.uk/doi/abs/10.1302/1358-992X.94BSUPP_XXII.BOFAS2010-003

Robinson, C., Otter, S.J., & C. Bowen. (2003). Clinical misdiagnosis of Morton’s neuroma: a case of early rheumatoid arthritis. British Journal of Podiatry, 6(3), 85-87. Retrieved from https://researchoutput.csu.edu.au/en/publications/clinical-misdiagnosis-of-mortons-neuroma-a-case-of-early-rheumato

 

References 

Gougoulias, N., Lampridis, V., & Sakellariou, A. (2019). Morton’s interdigital neuroma: instructional review. EFORT Open Reviews, 4(1), 14–24. DOI: 10.1302/2058-5241.4.180025.

Munir, U., Tafti, D., & Morgan, S. (2020). Morton Neuroma. In StatPearls. Treasure Island (FL): StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470249/.

Zabaglo, M., & Dreyer, M. A. (2020). Neuroma. In StatPearls. Treasure Island (FL): StatPearls 

Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK549838/.

Print this Article

Mini Disclaimer

User discretion: The material presented here is for your information and to be used for your reference only. Our volunteers have sourced this information from reputable sources and made sure it meets the quality standards at MARI. The information presented is not intended to be used as a diagnostic tool, a basis upon which to make diagnostic decisions, or to substitute the advice of a medical or healthcare professional. 

If you are a patient experiencing any of the listed symptoms, please consult a healthcare provider for specialized care and follow the instructions provided for you by your doctor. If you are in the US and would like advice on a possible case leading to errors in medicine, please reach out to our MARI Consultation team.

We appreciate your feedback!

Thank you for visiting our website. We are always looking for ways to improve. Please take a moment to tell us about your experience.