Introduction

Morton's neuroma is a benign neuroma affecting the intermetatarsal plantar nerve, most commonly in the third inter-metatarsophalangeal space. The female to male ratio is around 4:1.

Epidemiology

  • Incidence: 100.00 cases per 100,000 person-years
  • Peak incidence: 50-60 years
  • Sex ratio: more common in females 7:1
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Clinical features

Features
  • forefoot pain, most commonly in the third inter-metatarsophalangeal space
  • worse on walking. May be described as a shooting or burning pain. Patients may feel they have a pebble in their shoe
  • Mulder's click: one hand tries to hold the neuroma between the finger and thumb. The other hand squeezes the metatarsals together. A click may be heard as the neuroma moves between the metatarsal heads
  • there may be loss of sensation distally in the toes

Investigations

Diagnosis is usually clinical although ultrasound may be helpful in confirming the diagnosis.

Management

Management
  • avoid high-heels
  • metatarsal pad
  • CKS recommends referral if symptoms persist for > 3 months despite footwear modifications and the use of metatarsal pads
  • orthotists may give the patient a metatarsal dome orthotic
  • other secondary care options include corticosteroid injection and neurectomy of the involved interdigital nerve and neuroma