MORTON'S NEUROMA

SUMMARY

1. The most common location is between the third and fourth metatarsal heads, leading to referral of pain and paresthesia down the two toes.

2. Patients sometimes describe a sensation of having a pebble in their shoe or a wrinkle in their sock.

3. Pain is exacerbated with forefoot weight-bearing, narrow toe boxes, and high heels, all of which can load the pathologic region.

4. DDx: metatarsalgia.

5. Occasionally there's a click when palpating, especially when combined with squeezing the metatarsal heads together.

6. First-line interventions aim to unload the forefoot, local steroid injection, surgical excision of recalcitrant neuromas.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].