Morton’s Neuroma is a painful condition resulting from the fibrous thickening of the plantar interdigital nerve of the foot.
Often described as feeling like there is a pebble in the shoe, this is is a chronic condition not associated with acute trauma. It is gradual in onset but may present as acutely painful.
- AKA Morton’s metatarsalgia, or interdigital neuroma.
- Most commonly presents between the 3rd and 4th metatarsal head region, but can affect any of the toe spaces.
- More common in women (4-15 times) and between the ages of 40-60.
- Increasingly common in runners.
- Cause is uncertain but felt to be related to constriction of (e.g. ill fitting shoes) or pressure (e.g. heels, running, dancing) on the metatarsal head region.
Presentation (may include)
- Pain in forefoot exacerbated by certain footwear and extended weight bearing.
- Relieved by rest and massaging foot.
- Sensation of mass or pebble under forefoot, though unlikely to be palpable.
- Stabbing, burning, and or tingling sensation to forefoot and associated toes, worse on pressure.
Examination
- Pain on applying pressure to the affected area.
- Try to elicit Mulder’s click:
- Try to grip the neuroma between your forefinger and thumb (with your thumb on the plantar aspect of the foot).
- With your other hand, simultaneously squeeze the metatarsal heads (1-5) together in the transverse plane.
- A click can be felt and heard as the enlarged nerve subluxes between the metatarsal heads as they are compressed.
- Absence of this sign does not rule out neuroma.
- Loss of sensation to the affected toes is a strong indicator, but a sensory deficit may not be apparent.
Treatment
- Advice on use of footwear- Wide toed, flat, cushioned foot wear. No heels, No tight shoes, No thin soles
- Use an over the counter metatarsal pad or insole to relieve pressure to metatarsal head.
- Avoid aggravating activity, such as running. Or reduce as much as is feasible.
- Advise that this can be a long-term problem that may not respond to the above, or be relapsing in nature.
- Sign post to patient advice such as NHS Choices or Patient.co.uk
- If the patient has used the pads and appropriate footwear for 3 months to seek follow up from their GP with a view to specialist referral.
Further Reading
