Morton's Neuroma
What is it: A Morton's Neuroma is caused by impingement and irritation of the interdigital nerves of the foot as they pass between the metatarsal heads.
How does it present: Patients usually complain of pain in the forefoot, that they might be able to isolate as between the metatarsals. Pain increases with increased weight bearing activity and with ambulating barefoot. Patients may also complain of numbness that goes down into the toes.
Common exam findings: On the exam, patients are usually tender between the metatarsal heads. Morton's Neuromas are classically found between the third and fourth metatarsal heads, but can also be found commonly between the second and third. Compression of this area may also recreate numbness into the two associated toes. Patients may have a positive Mulder's Test as well.
Tests and treatment: No specific tests are needed to make the diagnosis of a morton’s neuroma. X-rays may be done to evaluated for bony abnormalities. Treatment is usually conservative with rest, and consideration of a metatarsal pad. In some cases corticosteroid injection may be considered. In recalcitrant cases, surgical excision may be needed, but this leaves numbness between the toes.