Feet

Question 1

Morton’s neuroma

Answer 1

Diagnosis confirmed with ultrasound. 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.

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

Question 2

how is Merton’s neuroma managed?

Answer 2

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