From the Guidelines
Morton's neuroma is a painful condition characterized by a thickening of tissue around a nerve leading to the toes, causing sharp, burning pain, numbness, and discomfort, typically diagnosed using MRI with a sensitivity of 87% and specificity of 100% 1. Morton's neuroma involves a thickening of tissue around a nerve, usually between the third and fourth toes, leading to symptoms such as sharp, burning pain, numbness, and a sensation like standing on a pebble or having a fold in your sock. Key characteristics of Morton's neuroma include:
- Thickening of tissue around a nerve leading to the toes
- Sharp, burning pain, numbness, and discomfort
- Typically occurs between the third and fourth toes
- Diagnosed using MRI, which has a high sensitivity and specificity 1 The diagnosis of Morton's neuroma is often made using imaging techniques, with MRI being a sensitive and reliable method to evaluate patients with metatarsalgia and Morton's neuroma 1. Treatment options for Morton's neuroma typically begin with conservative measures, including:
- Wearing wider shoes with lower heels
- Using metatarsal pads to relieve pressure
- Taking over-the-counter pain medications
- Resting the foot If these measures do not provide relief, a doctor may recommend corticosteroid injections or custom orthotics 1. In persistent cases, surgical removal of the affected nerve tissue may be necessary. Morton's neuroma develops when the nerve is repeatedly compressed or irritated, commonly from wearing tight shoes, high heels, or engaging in high-impact activities 1. People with certain foot deformities, such as bunions, hammertoes, or flat feet, are at higher risk of developing this condition.
From the Research
Definition of Morton's Neuroma
- Morton's neuroma is a common pathology affecting the forefoot, characterized as 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, 3.
- The condition results in benign perineural fibrosis of a common plantar digital nerve, leading to symptoms such as burning or shooting pain in the webspace that extends to the toes 3, 4.
Symptoms and Diagnosis
- Symptoms of Morton's neuroma include pain in the webspace, sensation of walking on a pebble, and impact on weight-bearing activities and quality of life 3, 4.
- Diagnosis is mainly based on characteristic symptoms and clinical findings, and can be confirmed by ultrasonography 3.
- Ultrasound is a highly accurate diagnostic tool for Morton's neuroma, but is subject to interoperator variability due to differences in technique and level of experience 3.
Treatment Options
- Treatment options for Morton's neuroma include orthotics, steroid injections, and surgical excision, usually performed through a dorsal approach 2.
- Corticosteroid injections have been shown to provide satisfactory outcomes, with maximal pain reduction between 1 week and 3 months after injection 5.
- However, almost 30% of patients may eventually undergo operative treatment due to persistent pain 5.
- Ultrasound-guided corticosteroid injections have been found to probably reduce pain and increase function compared to non-ultrasound-guided injections 4.