Plantar Digital Neuroma

Plantar Digital Neuroma also commonly known as Morton’s neuroma however there are neuromas of the 1st, 2nd and 4th interdigital spaces could be referred to as Heuter, Hauser and Iselin respectively. This is a thickening of one of the plantar digital nerves in your foot. The plantar digital nerves run between the long bones (metatarsals) in your feet and provide sensation to your patient's toes. The nerves most commonly involved are the ones that supply the 3rd and 4th toes but any of the plantar digital nerves can be affected.These nerves can experience a significant amount of stress and pressure which could result in damage and thickening to happen. Unfortunately, as the nerve thickens, the pressure around the nerve can increase resulting in pain and numbness in your forefoot and toes.

Patient Signs and Symptoms

Pain in the forefoot commonly in the third intermetatarsal space
Pain on using tight fitting shoes and relieved on removing footwear and massaging toes.
Reported sensation of a pebble or stone under the metatarsal
Sharp stabbing, tingling or burning pain in the nerve distribution.
Feels like a “Wrinkled sock”
Increased activity worsens pain

Significant Findings

Pain on squeezing met space
Mulders sign (click/ pop in plantar / dorsal pressure
Grauthiers Test (Pain on lateral foot squeeze)
Bratkowski Test (Digital nerve stretch test, hyperextending toes with thumb palpation may show thickened tender mass)
Tinels sign/ plantar or dorsal percussion
Apical sensation deficit for 10g/ light touch
Two or more positive tests is a strong indication.

Associated Findings

Sullivan’s sign (may indicate swollen plantar intermetatarsal bursitis)
Wide forefoot (hallux abductovalgus/Tailor's bunion)

Imaging

Not indicated at initial assessment unless history of trauma or to suspect osteomyelitis, however x-ray has low sensitivity and specificity for detecting acute osteomyelitis.

Diagnosis made by clinical signs as typically indicates accurate diagnosis.

Imaging maybe used at later date, can be discussed at our MSK Podiatry Virtual Escalation clinic as required on presentation.

Preferably weight bearing views in lateral, Dorsal/ Plantar and Oblique.

MSK Podiatry Virtual Escalation clinic