Morton Neuroma: Symptoms, Tests, and Treatments

What is another name for Interdigital Neuroma?

Morton or Intermetatarsal Neuroma.

What causes the irritation in Morton Neuroma?

Irritation and fibrous enlargement of the terminal branch of the Medial and Lateral Plantar nerves.

In what percentage of cases does Morton Neuroma occur in the 3rd webspace?

In 2/3 of cases.

In what percentage of cases does Morton Neuroma occur in the 2nd webspace?

In 1/3 of cases.

What anatomical structure can entrap the nerve in Morton Neuroma?

The transverse Metatarsal ligament.

What activities can irritate the nerve in Morton Neuroma?

Repetitive trauma from dancing or running, hyperpronated foot, and compression from shoes with a narrow toe box.

What symptoms do patients with Morton Neuroma report?

Sharp or dull pain, tingling or burning sensation in the intermetatarsal regions that radiate into two adjacent toes.

What sensation do patients often describe in relation to Morton Neuroma?

Feels like having a pebble in their shoe.

What makes symptoms of Morton Neuroma worse?

Wearing tight-fitting shoes with a narrow toe box.

What can recreate a patient's chief complaint in Morton Neuroma?

Intermetatarsal glides.

What are some differential diagnoses for Morton Neuroma?

Tarsal tunnel syndrome, plantar fasciitis, lumbar radiculopathy, diabetic neuropathy.

Special tests include

• Metatarsal (Morton) compression test

• Thumb-index finger squeeze test

• Mulder sign (combo platter of above tests)

• Tinel (dorsal, plantar)

- Positive test: reproduction of pain, numbness, or tingling

Metatarsal (Morton) compression test

Squeeze the outside of foot together

Thumb-index finger squeeze test

"Squeeze w/ two fingers" webspace at symptom location

What interventions are recommended for Morton Neuroma?

-Footwear modification

- restoring dorsiflexion

- local injections

- radiofrequency ablation

- surgical excision.

Radiofrequency ablation

a minimally invasive procedure that uses radiofrequency energy to create heat and destroy tissue,

What is the success rate of local injections for chronic complaints in Morton Neuroma?

82% success rate.

How much more likely are women to develop Morton Neuroma compared to men?

Women are 10 times more likely to have it than men.

In which demographic is Morton Neuroma more common?

In middle-aged individuals.

Which webspace is most commonly involved in Morton’s Neuroma?

3rd webspace (between 3rd and 4th toes)

Which webspace is the second most common site of involvement?

2nd webspace (between 2nd and 3rd toes)

___________________ of foot can cause Morton's Neuroma

Hyperpronation

How might a hyperpronated foot contribute to the condition?

It alters foot mechanics and increases stress on the intermetatarsal space, irritating the nerve.

Describe the classic sensory symptoms associated with Morton's Neuroma.

Tingling, burning, or radiating pain between toes (often 3rd and 4th)

What do patients commonly say the sensation feels like under their foot?

"Like having a pebble in their shoe"

Why might dancers and runners be more susceptible to developing Morton's Neuroma?

Repeated forefoot pressure and trauma increase risk of nerve irritation

Which clinical test combines elements of compression and shear forces on the nerve?

Mulder Sign

What type of conservative intervention focuses on unloading the nerve mechanically?

Footwear modification (wider toe box, soft soles, orthotics)

Name one non-surgical and one surgical intervention for chronic symptoms.

Non-surgical: Local injections (alcohol, steroid, anesthetics)

Surgical: Excision of the affected nerve

Which population is 10 times more likely to develop Morton's Neuroma?

Women (especially middle-aged)