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Morton's neuroma
Classification and external resources

The plantar nerves.
ICD-10 G57.6
ICD-9 355.6
DiseasesDB 8356
eMedicine orthoped/623 pmr/81 radio/882

Morton's neuroma (also known as Morton's metatarsalgia, Morton's neuralgia, plantar neuroma and intermetatarsal neuroma) is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the third and fourth intermetatarsal spaces.

This problem is characterised by numbness and pain, relieved by removing footwear.

Despite the name, the condition was first correctly described by a chiropodist named Durlacher,[1] and although it is labeled a "neuroma", many sources do not consider it a true tumor, but rather a perineural fibroma (fibrous tissue formation around nerve tissue).

Contents

Symptoms and signs

Symptoms include: pain on weight bearing, frequently after only a short time; the pain is felt as a shooting pain affecting the contiguous halves of two toes. Burning, numbness and parasthesia may also be experienced. The pain is caused by pressure on the enlarged section of nerve where it passes between the metatarsal heads, and is squeezed between them. The first toe is usually not involved. Neuroma in the 4th/5th interdigital space is described, but is extremely rare.

Morton's neuroma lesions have been found using MRI in patients without symptoms.[2]

Diagnosis/differential diagnosis

Negative signs include no obvious deformities, erythema, signs of inflammation or limitation of movement. Direct pressure between the metatarsal heads will replicate the symptoms, as will compression of the forefoot between the finger and thumb so as to compress the transverse arch of the foot. This is referred to as Mulder’s Sign.

There are other causes of pain in the forefoot. Too often all forefoot pain is categorized as neuroma. Other conditions to consider are capsulitis, which is an inflammation of ligaments that surrounds two bones, at the level of the joint. In this case it would be the ligaments that attach the phalanx (bone of the toe) to the metatarsal bone. Inflammation from this condition will put pressure on an otherwise healthy nerve and give neuroma type symptoms. Additionally, an intermetatarsal bursitis between the third and fourth metatarsal bones will also give neuroma type symptoms because it too puts pressure on the nerve. Freiberg's disease, which is an osteochondritis of the metatarsal head, causes pain on weight bearing or compression.

References

External links

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