II. Definitions
- Morton's Neuroma
- 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
- Footwear alteration (flat shoes to reduce pressure on Metatarsal heads)
- Metatarsal pad
- Pad to separate third and fourth Metatarsals heads
- Avoid tight fitting shoes
-
Morton's Neuroma Injection
- Better efficacy under Ultrasound guidance
-
Anesthetic alone is as effective as if combined with coticosteroid
- Anesthetic alone injections also avoids adverse effects (soft tissue atrophy)
- Surgery
- Indicated in failed conservative management
- Techniques (all with equivalent efficacy based on 2024 cochrane review)
- Nerve decompression
- Cryogenic neuroablation
- Surgical Excision of Neuroma