Morton neuroma
Morton neuroma is compressive, degenerative injury of a common digital nerve between the metatarsal heads, most often in the third interspace, causing burning forefoot pain, toe paresthesia, and the sensation of walking on a pebble. It is a clinical diagnosis made from focal interspace tenderness reproduced by squeezing the metatarsals, treated first with footwear modification, padding, and NSAIDs, then corticosteroid injection, with nerve resection for refractory cases.
- Topic reviewThe full article, organized the way the exam asks it.
- ABIM-format MCQsVignettes with an explanation for every wrong answer.
- Key factsThe numbers and thresholds worth memorizing, up front.
- AI tutorMedBrain answers the question you're stuck on.
What this article covers
- Overview
Definition: Morton neuroma is a compressive, neuropathic degeneration of a common digital nerve as it passes between the metatarsal heads, also called interdigital nerve injury.
- Epidemiology
Seen most often in women who wear high heels, which drive the metatarsal heads together and load the forefoot.
- Risk factors
High-heeled shoes: the strongest and most modifiable factor, squeezing the metatarsal heads together and compressing the nerve.
- Pathophysiology
Compression comes first: the common digital nerve is compressed between adjacent metatarsal heads, most often in the third interspace, as the forefoot is loaded.
- Clinical features
Pain between the metatarsal heads with the sensation of walking on a pebble is the hallmark; with focal interspace tenderness it establishes the clinical diagnosis.
- Differential diagnosis
Metatarsal stress fracture: localized bony tenderness with pain on percussion or single-leg hopping in a runner, on the metatarsal shaft rather than between the heads; see stress-fracture.
- Diagnosis
Morton neuroma is a clinical diagnosis established by forefoot pain between the metatarsal heads (most often the third interspace) with the sensation of walking on a pebble, toe paresthesia, and…
- Management
First, start footwear modification for every patient: stop high heels and shoes that squeeze the forefoot, reduce prolonged standing and hard-surface running, and add padding or padded shoe inserts…
- Complications
Chronic, refractory forefoot pain that limits walking, standing, and running.
- Prognosis
Many patients improve with conservative care: avoidance of high heels and prolonged standing, orthotics, NSAIDs, and corticosteroid injection are effective treatment options.
- Prevention
Avoid high heels and shoes that squeeze the forefoot, the main modifiable cause of metatarsal head compression.
Read the whole article
Subscribing to Internal Medicine opens every article, the full question bank and MedBrain, on the web, iPhone and Android.
Related articles
- Common adult foot deformities
Common adult foot deformities include hallux valgus (bunion), hammertoe, and pes planus or pes cavus, each diagnosed by inspection of the standing, weight-bearing foot and managed first with footwear modification and orthoses before surgery is considered.
- Stress fracture
Stress fracture is a bone injury from repetitive submaximal load that outpaces bone remodeling, most often in the foot or tibia in runners, and management is dictated by the anatomic site's nonunion risk rather than by pain alone.
- Plantar fasciitis
Plantar fasciitis is a clinical diagnosis made from sharp medial-inferior heel pain worst with the first morning steps and a tender medial calcaneal tubercle, treated first with stretching, footwear correction, and NSAIDs before escalating to injection.
- Gout
Gout is a crystal arthropathy in which monosodium urate deposits from chronic hyperuricemia trigger acute inflammatory arthritis, classically podagra of the first metatarsophalangeal joint. Diagnosis rests on negatively birefringent needle-shaped crystals in synovial fluid, and treatment pairs anti-inflammatory therapy for the flare with lifelong urate-lowering therapy to a serum urate below 6 mg/dL.
- Rheumatoid arthritis
Rheumatoid arthritis is a chronic systemic autoimmune disease causing symmetric small-joint polyarthritis of the hands and feet that spares the distal interphalangeal joints, with morning stiffness over an hour. Diagnosis combines the ACR/EULAR classification criteria with rheumatoid factor, anti-CCP antibody, and radiographs. Treat-to-target management anchors on methotrexate, escalating to a biologic or targeted synthetic disease-modifying antirheumatic drug when remission is not reached.
- Diabetic neuropathy
Diabetic neuropathy is length-dependent nerve damage from chronic hyperglycemia, most often a distal symmetric sensorimotor polyneuropathy causing numbness, pain, and loss of ankle reflexes, with autonomic, mononeuropathy, and radiculoplexus variants. Diagnosis is clinical after excluding other causes; management is tight glycemic control plus gabapentinoid or duloxetine therapy for painful symptoms.