Morton's neuroma

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Morton's neuroma

Orthopedics A type of perineural fibrosis, which is not a true neuroma Clinical Sharp, burning pain, commonly between the 3rd and 4th metatarsal heads, worse with pressure, better with rest Management Conservative–metatarsal pads in insole, loose footwear–ie, tight high heels, ski boots, bike shoes ganz verboten; blocks with a local anesthetic and steroids; surgery if conservative measures fail; if Sx are limited to one web space, surgical outcome is excellent in up to 90%

Morton's neuroma

A condition featuring painful enlargement of interdigital nerves between the third and fourth metatarsal heads. Also called interdigital neuroma. Treatment is by change of footwear, steroid injections or surgical excision of the affected nerve.

Morton's neuroma

; plantar digital neuroma; plantar digital neuritis second or third proper plantar digital nerve entrapment neuropathy secondary to excess local plantar pressure at toe off (e.g. wearing high heels, partially compensated forefoot varus/supinatus or valgus, compensated rearfoot varus, mobile pes cavus; see Table 1); presents with localized spasmodic discomfort and pain, and progresses to severe, lancinating, distally radiating pain of intermetatarsal/web space (e.g. sensation of walking on a lump or pebble) together with paraesthesia/numbness of adjacent toes, especially in overpronating forefoot; symptoms are caused by compression of affected plantar digital nerve (against overlying deep transverse intermetatarsal ligament) and ischaemia (compression of intermetatarsal artery by distal protrusion of intermetatarsal bursa at toe off); affected nerve area develops a fusiform swelling and may require surgical excision (neurectomy)
Table 1: Presentations of nerve trunk irritation in the foot
Neuroma/lesionInvolved nerveLocation
Proximal tarsal tunnel syndromeBranches of the posterior tibial nerveMedial ankle area
Distal tarsal tunnel syndrome Jogger's footMedial plantar nerveBetween navicular tuberosity and belly of abductor hallucis
Distal tarsal tunnel syndrome Baxter's neuritisLateral plantar nerveBetween bellies of abductor hallucis, quadratus plantae and abductor digiti quinti minimi
Joplin's neuromaMedial plantar nerve properMedial area of first metatarsal head
Houser's neuromaFirst plantar intermetatarsal nerveBetween 1 and 2 metatarsals
Heuter's neuromaSecond plantar intermetatarsal nerveBetween 2 and 3 metatarsals
Morton's neuromaThird plantar intermetatarsal nerveBetween 3 and 4 metatarsals
Islen's neuromaFourth plantar intermetatarsal nerveBetween 4 and 5 metatarsals