Practice Essentials

Morton neuroma (interdigital neuroma), first described in 1876, is a perineural fibrosis and nerve degeneration of the common digital nerve.^{[1, 2]} Morton neuroma, or Morton's neuroma, is not a true neuroma, although it results in neuropathic pain in the distribution of the interdigital nerve secondary to repetitive irritation of the nerve. The most frequent location is between the third and fourth metatarsals (third webspace). Other, less common locations are between the second and third metatarsals (second webspace) and, rarely, between the first and second (first webspace) or fourth and fifth (fourth webspace) metatarsals.^[3] When conservative measures for Morton's neuroma are unsuccessful, surgical excision of the area of fibrosis in the common digital nerve may be curative.

Plantar view showing the relationships between the metatarsal heads, the intermetatarsal ligament, and the neuroma.

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Neuroma and adherent fibrofatty tissue.

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Episodes of pain are intermittent. Patients may experience 2 attacks in a week and then none for a year. Recurrences are variable and tend to become more frequent. Between attacks, no symptoms or physical signs occur. Two neuromas coexist on the same foot about 2-3% of the time. Other diagnoses should be considered when 2 or more areas of tenderness are present.

Symptoms of Morton’s neuroma

Symptoms of Morton’s neuroma include the following:

The most common presenting complaints include pain and dysesthesias in the forefoot and corresponding toes adjacent to the neuroma
Pain is described as sharp and

Pathophysiology

Interdigital nerves are composed of communicating branches from the lateral and medial plantar nerves. At the level of the metatarsal heads, the interdigital nerve traverses inferior to the intermetatarsal ligament. At this site, the nerve may be compressed or stretched from repetitive toe flexion and extension. Other studies have shown perineural fibrosis and demyelination at the level of the metatarsal heads, indicating that the damage in Morton's neuroma may be more distal than the intermetatarsal ligament.^[12]

Next: Pathophysiology

Epidemiology

Frequency

United States

Morton's neuroma is a common disease entity of the foot.

International

The incidence of Morton's neuroma is presumed to be the same internationally as in United States.

Sex

The female-to-male ratio for Morton's neuroma is 5:1.

Age

The highest prevalence of Morton's neuroma is found in patients aged 15-50 years, but the condition may occur in any ambulatory patient.

Clinical Presentation

Morton TG. Peculiar painful affection of fourth metatarsophalangeal articulation. Am J Med Sci. 1876. 71:37.
Munir U, Tafti D, Morgan S. Morton Neuroma. StatPearls. 2023 May 22. [QxMD MEDLINE Link]. [Full Text].
Valero J, Gallart J, Gonzalez D, Deus J, Lahoz M. Multiple interdigital neuromas: a retrospective study of 279 feet with 462 neuromas. J Foot Ankle Surg. 2015 May-Jun. 54 (3):320-2. [QxMD MEDLINE Link].
Zanetti M, Weishaupt D. MR imaging of the forefoot: Morton neuroma and differential diagnoses. Semin Musculoskelet Radiol. 2005 Sep. 9(3):175-86.
Claassen L, Bock K, Ettinger M, Waizy H, Stukenborg-Colsman C, Plaass C. Role of MRI in detection of Morton's neuroma. Foot Ankle Int. 2014 Oct. 35 (10):1002-5. [QxMD MEDLINE Link].
Pastides P, El-Sallakh S, Charalambides C. Morton's neuroma: A clinical versus radiological diagnosis. Foot Ankle Surg. 2012 Mar. 18(1):22-4. [QxMD MEDLINE Link].
Xu Z, Duan X, Yu X, Wang H, Dong X, Xiang Z. The accuracy of ultrasonography and magnetic resonance imaging for the diagnosis of Morton's neuroma: a systematic review. Clin Radiol. 2015 Apr. 70 (4):351-8. [QxMD MEDLINE Link].
Ata AM, Onat SS, Ozcakar L. Ultrasound-Guided Diagnosis and Treatment of Morton's Neuroma. Pain Physician. 2016 Feb. 19 (2):E355-8. [QxMD MEDLINE Link]. [Full Text].
Bignotti B, Signori A, Sormani MP, Molfetta L, Martinoli C, Tagliafico A. Ultrasound versus magnetic resonance imaging for Morton neuroma: systematic review and meta-analysis. Eur Radiol. 2015 Aug. 25 (8):2254-62. [QxMD MEDLINE Link].
Morgan P, Monaghan W, Richards S. A systematic review of ultrasound-guided and non-ultrasound-guided therapeutic injections to treat Morton's neuroma. J Am Podiatr Med Assoc. 2014 Jul. 104 (4):337-48. [QxMD MEDLINE Link].
Mahadevan D, Attwal M, Bhatt R, Bhatia M. Corticosteroid injection for Morton's neuroma with or without ultrasound guidance: a randomised controlled trial. Bone Joint J. 2016 Apr. 98-B (4):498-503. [QxMD MEDLINE Link].
Kim JY, Choi JH, Park J, et al. An anatomical study of Morton's interdigital neuroma: the relationship between the occurring site and the deep transverse metatarsal ligament (DTML). Foot Ankle Int. 2007 Sep. 28(9):1007-10. [QxMD MEDLINE Link].
Mahadevan D, Venkatesan M, Bhatt R, Bhatia M. Diagnostic Accuracy of Clinical Tests for Morton's Neuroma Compared With Ultrasonography. J Foot Ankle Surg. 2015 Jul-Aug. 54 (4):549-53. [QxMD MEDLINE Link].
O'Connor FG, Wilder RP, Nirschl R. Foot Injuries in the Runner. In:Textbook of Running Medicine. New York: McGraw-Hill; 2001. 258-260.
Akermark C, Saartok T, Zuber Z. A prospective 2-year follow-up study of plantar incisions in the treatment of primary intermetatarsal neuromas (Morton's neuroma). Foot Ankle Surg. 2008. 14(2):67-73. [QxMD MEDLINE Link].
Monacelli G, Cascioli I, Prezzemolo G, Spagnoli A, Irace S. [Surgical treatment of Morton's neuroma: our experience and literature review]. Clin Ter. 2008 May-Jun. 159(3):165-7. [QxMD MEDLINE Link].
Valente M, Crucil M, Alecci V. Operative treatment of interdigital Morton's neuroma. Chir Organi Mov. 2008 May. 92(1):39-43. [QxMD MEDLINE Link].
Lee KT, Lee YK, Young KW, et al. Results of operative treatment of double Morton's neuroma in the same foot. J Orthop Sci. 2009 Sep. 14(5):574-8. [QxMD MEDLINE Link].
Bucknall V, Rutherford D, MacDonald D, Shalaby H, McKinley J, Breusch SJ. Outcomes following excision of Morton's interdigital neuroma: a prospective study. Bone Joint J. 2016 Oct. 98-B (10):1376-81. [QxMD MEDLINE Link].
Valisena S, Petri GJ, Ferrero A. Treatment of Morton's neuroma: a systematic review. Foot Ankle Surg. 2017 Apr 5. [QxMD MEDLINE Link].
Villas C, Florez B, Alfonso M. Neurectomy versus neurolysis for Morton's neuroma. Foot Ankle Int. 2008 Jun. 29(6):578-80. [QxMD MEDLINE Link].
Title CI, Schon LC. Morton neuroma: primary and secondary neurectomy. J Am Acad Orthop Surg. 2008 Sep. 16(9):550-7. [QxMD MEDLINE Link].
Pace A, Scammell B, Dhar S. The outcome of Morton's neurectomy in the treatment of metatarsalgia. Int Orthop. 2010 Apr. 34(4):511-5. [QxMD MEDLINE Link].
Faraj AA, Hosur A. The outcome after using two different approaches for excision of Morton's neuroma. Chin Med J (Engl). 2010 Aug. 123(16):2195-8. [QxMD MEDLINE Link].
Kundert HP, Plaass C, Stukenborg-Colsman C, Waizy H. Excision of Morton's Neuroma Using a Longitudinal Plantar Approach: A Midterm Follow-up Study. Foot Ankle Spec. 2015 Aug 7. [QxMD MEDLINE Link].
Habashy A, Sumarriva G, Treuting RJ. Neurectomy Outcomes in Patients With Morton Neuroma: Comparison of Plantar vs Dorsal Approaches. Ochsner J. 2016 Winter. 16 (4):471-4. [QxMD MEDLINE Link]. [Full Text].
Killen MC, Karpe P, Limaye R. Plantar approach for Morton's neuroma: an effective technique for primary excision. Foot (Edinb). 2015 Dec. 25 (4):232-4. [QxMD MEDLINE Link].
Lee W, McDonald J, Azam M, Lachance AD. The comparison of postoperative outcomes in Morton's neuroma excision between plantar versus dorsal approach: A systematic review and meta-analysis. Foot Ankle Surg. 2024 Jun 5. [QxMD MEDLINE Link].
Reichert P, Zimmer K, Witkowski J, Wnukiewicz W, Kulinski S, Gosk J. Long-Term Results of Neurectomy Through a Dorsal Approach in the Treatment of Morton's Neuroma. Adv Clin Exp Med. 2016 Mar-Apr. 25 (2):295-302. [QxMD MEDLINE Link].
Lee J, Kim J, Lee M, Chu I, Lee S, Gwak H. Morton's Neuroma (Interdigital Neuralgia) Treated with Metatarsal Sliding Osteotomy. Indian J Orthop. 2017 Nov-Dec. 51 (6):692-6. [QxMD MEDLINE Link]. [Full Text].
Rout R, Tedd H, Lloyd R, et al. Morton's neuroma: diagnostic accuracy, effect on treatment time and costs of direct referral to ultrasound by primary care physicians. Qual Prim Care. 2009. 17(4):277-82. [QxMD MEDLINE Link].
Yap LP, McNally E. Patient's assessment of discomfort during ultrasound-guided injection of Morton's neuroma: selecting the optimal approach. J Clin Ultrasound. 2012 May 15. [QxMD MEDLINE Link].
Markovic M, Crichton K, Read JW, et al. Effectiveness of ultrasound-guided corticosteroid injection in the treatment of Morton's neuroma. Foot Ankle Int. 2008 May. 29(5):483-7. [QxMD MEDLINE Link].
Edwards SR, Fleming S, Landorf KB. Efficacy of a Single Corticosteroid Injection for Morton's Neuroma in Adults: A Systematic Review. J Am Podiatr Med Assoc. 2021 Jul 1. 111 (4):[QxMD MEDLINE Link].
Hau MYT, Thomson L, Aujla R, Madhadevan D, Bhatia M. Medium-Term Results of Corticosteroid Injections for Morton's Neuroma. Foot Ankle Int. 2021 Apr. 42 (4):464-8. [QxMD MEDLINE Link].
Lizano-Diez X, Gines-Cespedosa A, Alentorn-Geli E, et al. Corticosteroid Injection for the Treatment of Morton's Neuroma: A Prospective, Double-Blinded, Randomized, Placebo-Controlled Trial. Foot Ankle Int. 2017 Sep. 38 (9):944-51. [QxMD MEDLINE Link].
Park YH, Kim TJ, Choi GW, Kim HJ. Prediction of Clinical Prognosis according to Intermetatarsal Distance and Neuroma Size on Ultrasonography in Morton Neuroma: A Prospective Observational Study. J Ultrasound Med. 2019 Apr. 38 (4):1009-14. [QxMD MEDLINE Link]. [Full Text].
Fridman R, Cain JD, Weil L Jr. Extracorporeal shockwave therapy for interdigital neuroma: a randomized, placebo-controlled, double-blind trial. J Am Podiatr Med Assoc. 2009 May-Jun. 99(3):191-3. [QxMD MEDLINE Link].
Moore JL, Rosen R, Cohen J, Rosen B. Radiofrequency thermoneurolysis for the treatment of Morton's neuroma. J Foot Ankle Surg. 2012 Jan-Feb. 51(1):20-2. [QxMD MEDLINE Link].
Moulin B, Angelopoulos G, Sarrazin JL, et al. Safety and Efficacy of Percutaneous Morton Neuroma Cryoneurolysis Under Ultrasound Guidance. Cardiovasc Intervent Radiol. 2024 Jun. 47 (6):795-800. [QxMD MEDLINE Link].
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Media Gallery

Plantar view showing the relationships between the metatarsal heads, the intermetatarsal ligament, and the neuroma.
Neurectomy: typical incision location.
Neurectomy: superficial exposure.
Neurectomy: deeper dissection.
Neuroma and adherent fibrofatty tissue.

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Sections Physical Medicine and Rehabilitation for Morton Neuroma
Overview
Presentation
- History
- Physical
- Causes
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DDx
Workup
Treatment
Medication
Follow-up
Media Gallery
References

Physical Medicine and Rehabilitation for Morton Neuroma

Practice Essentials

Symptoms of Morton’s neuroma

Pathophysiology

Epidemiology

Frequency

Sex

Age

References

Tables

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