Morton's neuroma Flashcards
What is Morton’s neuroma?
This is the degenerative fibrosis of a digital nerve near its bifurcation, caused by irritation
How does Morton’s neuroma occur?
The plantar interdigital nerves overlying the intermetatarsal ligaments can be subjected to repeated trauma, with the irritated nerves becoming inflamed and swollen
What is the most commonly affected nerve space affected by Morton’s neuroma?
3rd internerve space
What are some presentations of Morton’s neuroma?
This causes forefoot pain (Metatarsalgia), as well as burning and tingling in the toes
How will pain present in Mortons neuroma?
Pain is often exacerbated by footwear and is relieved by removal of the shoe, massing of the foot or changing footwear
What are some clinical signs of Morton’s neuroma?
Some signs include loss of sensation in the affected webspace, and Mulder’s click test
What is Mulder’s click test for Morton’s neuroma?
Mulder’s click test involves medio‐lateral compression of the metatarsal heads (exerted by squeezing the forefoot with your hand), which may reproduce symptoms or produce a characteristic ‘click’
What investigations are required in Morton’s neuroma?
Investigation required is an USS to show the swollen nerve, however, this has poor specificity as there is a risk of a false positive if <6mm in diameter
X-ray can be taken to rule out MSK pathology
What are the main management options in Morton’s neuroma?
Management is either non-operative, using insoles, RICE, weight loss and injections, or operative, with excision
When is surgery indicated in Morton’s neuroma?
Surgery is indicated if symptoms persist after 2-3 months of footwear modification and metatarsal pads, and there is then an inadequate response to corticosteroid injection
