II. Definition

  1. Perineural fibrosis of plantar nerve
  2. Affects medial and lateral plantar branch communication

III. Mechanism

  1. Repetitive Trauma
  2. Secondary Fibrosis
  3. Painful fusiform swelling of nerve

IV. Epidemiology

  1. Women more often affected than Men

V. Symptoms

  1. Severe burning pain at third web space
  2. Numbness in affected toes
  3. Radiation of pain into third and fourth toes
  4. Provocative
    1. Worse with activity
    2. Aggravated by tight shoes
  5. Palliative
    1. Relieved by removing shoe
    2. Relieved by massaging foot

VI. Signs

  1. Mulder Click Test
    1. Dorsiflex the foot
    2. Squeezing the Metatarsals results in a "clicking" sound in Morton's Neuroma

VII. Differential Diagnosis

  1. Plantar Fasciitis (if affecting tibial nerve in proximal foot)

VIII. Management: Conservative therapy

  1. Often does not provide relief
  2. Pad to separate third and fourth Metatarsals heads
  3. Avoid tight fitting shoes
  4. Morton's Neuroma Injection

IX. Management: Surgery

  1. Corticosteroid Injection
  2. Surgical Excision of Neuroma
    1. Indicated in failed conservative management

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