From the Guidelines
Morton neuroma diagnosis should primarily rely on MRI due to its high sensitivity and specificity, as evidenced by a pooled sensitivity of 93% and specificity of 68% in a meta-analysis 1. When evaluating patients with suspected Morton's neuroma, it is essential to consider the most effective diagnostic tools. The use of MRI has been shown to have a significant impact on diagnostic and therapeutic decisions made by orthopedic surgeons, increasing their confidence levels and changing treatment plans 1.
Key Diagnostic Considerations
- MRI sensitivity: 93% 1
- MRI specificity: 68% 1
- MRI positive likelihood ratio: 1.89 1
- MRI negative likelihood ratio: 0.19 1
Treatment Options
Treatment for Morton's neuroma typically begins with conservative measures, including:
- Wearing wider shoes with lower heels
- Using metatarsal pads
- Taking over-the-counter pain medications like ibuprofen or naproxen
- Resting the foot If these measures fail, corticosteroid injections or surgical removal of the affected nerve tissue may be necessary. However, the primary focus should be on accurate diagnosis using MRI to guide treatment decisions 1.
From the Research
Definition and Causes of Morton's Neuroma
- Morton's neuroma is a common pathology affecting the forefoot, characterized by fibrosis of the nerve, not a true neuroma 2.
- It is caused by pressure or repetitive irritation leading to thickness of the digital nerve, typically located in the third or second intermetatarsal space 2.
Symptoms of Morton's Neuroma
- Symptoms include burning or shooting pain in the webspace that extends to the toes, or the sensation of walking on a pebble 3.
- These symptoms can impact weight-bearing activities and quality of life 3.
Treatment Options for Morton's Neuroma
- Treatment options include orthotics, steroid injections, and surgical excision, usually performed through a dorsal approach 2.
- Nonsurgical treatments, such as corticosteroid and local anaesthetic injection (CS+LA), may result in little to no difference in pain or function compared to local anaesthetic injection (LA) alone 3.
- Ultrasound-guided (UG) CS+LA may reduce pain and increase function compared to non-ultrasound-guided (NUG) CS+LA 3.
- Surgical treatments, such as plantar incision neurectomy (PN) and dorsal incision neurectomy (DN), may have varying outcomes, but the evidence is limited 3.
- Infiltrative treatments, including corticosteroids, sclerosing solutions, and other substances, have shown efficacy in reducing pain related to Morton's neuroma 4.
- Capsaicin, corticosteroids, alcohol, and hyaluronic acid injections have been reported to be effective in reducing pain, with capsaicin producing a 51.8% reduction in VAS score 4.
Efficacy of Specific Treatments
- A prospective, double-blinded, randomized, placebo-controlled trial found no significant difference in pain and function improvement between corticosteroid injection and local anesthetic alone 5.
- A histologic study found that 4% ethanol sclerosing injection can cause histologic changes in Morton's neuroma, contrary to previous findings 6.