Is a painful benign fibrotic enlargement of one of there common digital nerves. It is caused by a shearing force of the adjacent metatarsal bone. It most commonly affects the third common digital nerve. Morton's Neuroma is found to be more common in females. This may be related to the type of shoe gear often worn by females. It is most common in the 4th - 6th decade.
History
Obtaining an accurate history is important to making the diagnosis of Morton's neuroma.
Common Findings
Pain in the forefoot and corresponding toes adjacent to the neuroma
Pain is usually described as sharp and burning
Pain may radiate proximal
Numbness and tingling often is observed in the toes adjacent to the neuroma
Intermittent pain
Massage of the affected area may give some relief
Narrow tight high-heeled shoes aggravate the symptoms
Patients may feel as though they are walking on a wrinkle in there sock
Exam
Firm squeezing of the metatarsal heads with one hand while applying direct pressure to the dorsal and plantar interspace with the other hand may elicit radiating pain.
Mulder Sign - A silent palpable click produced by the lateral squeeze test. The neuroma moves between the metatarsals.
Passive and active bending of the toe in an upward direction may aggravate symptoms.
Sullivan's Sign - Toes adjacent to the affected interspace splay apart on weight bearing.
Imaging
Ultrasonography
MRI
Differential Diagnosis
Stress fracture of the metatarsal
Rheumatoid arthritis
Hammertoe
Metatarsalgia- plantar tenderness over the metatarsal head
Neoplasms
Metatarsal head osteonecrosis
Freiburg osteochondrosis- characterized by interruption of the blood supply of a bone followed by localized bony necrosis.
Ganglion cysts
Intermetatarsal bursal fluid collections
Treatment
Treatment strategies for Morton's neuroma range from conservative to surgical management.
Conservative
Bio mechanical
Orthotics
Medications
Injections- Corticosteroid- Anti inflammatory agent
Alcohol sclerosing- Causes a chemical neurolysis of the nerve and used as an alternative to surgery for Morton's neuroma
NSAID's- Non Steroidal Anti Inflammatory such as Ibuprofen or Naprosyn
Tricyclic Antidepressants- Amitriptyline(Elavil)
Anticonvulsants- Neurontin (Gabapentin)
Pregabalin (Lyrica)
Duloxetine (Cymbalta)
Rehabilitation Program Physical Therapy
Cryotherapy-Cold Therapy- Cold may be applied using an ice bag or a cold pack
Ultrasonography- Sound waves that are transferred to a specific body area via a round-headed probe. The sound waves travel deep into tissue, creating gentle heat. The heat helps relieve pain and inflammation
Deep tissue massage
Stretching exercises
Phonophoresis- Has been used in an effort to enhance the absorption of topically applied analgesics and anti-inflammatory agents through the therapeutic application of ultrasound
Surgical Intervention
Neurectomy- When conservative measures for Morton's neuroma are unsuccessful surgical excision may be beneficial
Is a painful benign fibrotic enlargement of one of there common digital nerves. It is caused by a shearing force of the adjacent metatarsal bone. It most commonly affects the third common digital nerve. Morton's Neuroma is found to be more common in females. This may be related to the type of shoe gear often worn by females. It is most common in the 4th - 6th decade.
History
Obtaining an accurate history is important to making the diagnosis of Morton's neuroma.
Common Findings
Exam
Imaging
Differential Diagnosis
Treatment
Treatment strategies for Morton's neuroma range from conservative to surgical management.
Conservative
Bio mechanical
Medications
Rehabilitation Program
Physical Therapy
Surgical Intervention