II. Definition
- Perineural fibrosis of plantar nerve
- Affects medial and lateral plantar branch communication
III. Mechanism
- Repetitive Trauma
- Secondary Fibrosis
- Painful fusiform swelling of nerve
IV. Epidemiology
- Women more often affected than Men
V. Symptoms
- Severe burning pain at third web space
- Numbness in affected toes
- Radiation of pain into third and fourth toes
- Provocative
- Worse with activity
- Aggravated by tight shoes
- Palliative
- Relieved by removing shoe
- Relieved by massaging foot
VI. Signs
- Mulder Click Test
- Dorsiflex the foot
- Squeezing the Metatarsals results in a "clicking" sound in Morton's Neuroma
VII. Differential Diagnosis
- Plantar Fasciitis (if affecting tibial nerve in proximal foot)
VIII. Management: Conservative therapy
- Often does not provide relief
- Pad to separate third and fourth Metatarsals heads
- Avoid tight fitting shoes
- Morton's Neuroma Injection
IX. Management: Surgery
- Corticosteroid Injection
- Surgical Excision of Neuroma
- Indicated in failed conservative management