From the Guidelines
No, pain on Mulder's Click alone is not sufficient to indicate Morton's neuroma, as diagnosis typically involves a combination of clinical history, physical examination, and imaging studies like ultrasound or MRI, which have high sensitivities of 83%-96% and 82%-96%, respectively, in detecting Morton’s neuromas 1.
Clinical Presentation of Morton's Neuroma
Morton's neuroma presents with a range of symptoms, including burning pain, tingling, or numbness between the toes, most commonly the third and fourth toes. These symptoms worsen with walking and improve with rest. Patients often describe the sensation as feeling like they're "walking on a pebble" or having a "bunched-up sock" under their foot. Other indicators include pain radiating to the toes, relief when removing shoes or massaging the foot, and pain exacerbation when wearing narrow or tight footwear.
Diagnostic Approaches
Diagnosis of Morton's neuroma involves a combination of clinical history, physical examination, and imaging studies. Mulder's Click test can be useful, as it can produce pain and sometimes an audible click in patients with Morton's neuroma. However, this test is not definitive on its own, as other conditions like metatarsalgia, stress fractures, or intermetatarsal bursitis can present with similar symptoms. Imaging studies, particularly ultrasound and MRI, are considered reliable methods for evaluating patients with Morton’s neuroma, with high-resolution ultrasound approaching the sensitivity of MRI in detecting Morton’s neuromas 1.
Imaging Studies
Ultrasound and MRI are both effective in diagnosing Morton's neuroma, with sensitivities of 83%-96% and 82%-96%, respectively. High-resolution ultrasound has the advantage of allowing clinical correlation during examination and has been found to have higher diagnostic capabilities than MRI in some studies, with pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 90%, 88%, 2.77, and 0.16 for ultrasound 1.
Conclusion is not allowed, so the answer just ends here.
From the Research
Diagnosis of Morton's Neuroma
- The diagnosis of Morton's neuroma is based on a combination of clinical examination, patient history, and physical findings, including pain in the forefoot, which worsens with walking, and local interdigital tenderness 2.
- Mulder's Click is a clinical test used to diagnose Morton's neuroma, which involves compressing the affected intermetatarsal space to elicit a palpable and audible click, indicating the presence of a neuroma 3.
- However, pain on the Mulder's Click alone may not be sufficient to indicate Morton's neuroma, as other conditions can also cause pain in the forefoot.
Clinical Findings and Diagnosis
- A retrospective study of 67 patients with Morton's neuroma found that 78% were women, with an average age of 58 years, and presented with pain in the forefoot that worsened with walking 2.
- The presence of local interdigital tenderness led to the diagnosis of Morton's neuroma, and modification of shoes was helpful in some patients 2.
- A systematic review of infiltrative treatment for Morton's neuroma found that corticosteroids, sclerosant injections, hyaluronic acid, and capsaicin were effective in reducing pain related to Morton's neuroma 4.
Treatment Options
- Treatment options for Morton's neuroma include orthotics, steroid injections, and surgical excision, usually performed through a dorsal approach 3.
- A prospective, double-blinded, randomized, placebo-controlled trial found that corticosteroid injection was not superior to local anesthetic alone in terms of pain and function improvement in patients with Morton's neuroma 5.
- A systematic review of corticosteroid injections for Morton's interdigital neuroma found that corticosteroid injections provided satisfactory outcomes, although almost 30% of patients eventually underwent operative treatment due to persistent pain 6.