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

Diagnosis is usually clinical although ultrasound may be helpful in confirming the diagnosis.

Management

• 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