Morton’s interdigital neuroma: instructional review

Abstract

The terminology ‘Morton’s neuroma’ may represent a simplification of the clinical condition as the problem may not be a benign tumour of the nerve, but neuropathic foot pain associated with the interdigital nerve.Foot and ankle pathomechanics leading to metatarsalgia, clinical examination and differential diagnosis of the condition and imaging of the condition, for differential diagnosis, are discussed.Nonoperative management is recommended initially. Physiotherapy, injections (local anaesthetic, steroid, alcohol), cryotherapy, radiofrequency ablation and shockwave therapy are discussed.Operative treatment is indicated after nonoperative management has failed. Neuroma excision has been reported to have good to excellent results in 80% of patients, but gastrocnemius release and osteotomies should be considered so as to address concomitant problems.Key factors in the success of surgery are correct diagnosis with recognition of all elements of the problem and optimal surgical technique.Cite this article: EFORT Open Rev 2019;4:14-24. DOI: 10.1302/2058-5241.4.180025.

Morton Neuroma Surgery: Relation Clinical Results to Excised Sample Length

“…The cause of MN has not clearly been established (2,9,10). This confusion also leads to confusion in the choice of treatment.…”

“…Conservative treatment modalities for MN consist of shoe modi cations, orthotic use, corticosteroid injections (2). Surgical applications that can be selected from one of two surgical entry points as either dorsal or plantar may be last chance for failed treatments.…”

“…Surgical applications that can be selected from one of two surgical entry points as either dorsal or plantar may be last chance for failed treatments. Surgical techniques may be either decompression or excision with either open or endoscopic manner (2).…”

Is it time to rethink the diagnosis of Morton’s Neuroma?

“…The condition was described by its namesake Doctor Thomas Morton in 1876, as a peculiar and painful affection of the fourth metatarsophalangeal joint [4]. Other physicians have described the condition as 'a painful clinical syndrome of the forefoot', thus representing an over simplification of the clinical diagnosis and potentially misleading many healthcare providers and patients alike [5]. The terminology 'neuroma' is misleading as the condition is not a benign tumor of the nerve but rather a neuropathic pain in the forefoot associated with the interdigital nerve (most commonly between the third and fourth metatarsal heads) [5].…”

“…The literature offers multiple treatment modalities for this condition including, extracorporeal shockwave therapy, site injection, surgery as well as a variety of conservative methods such as orthotic inserts or footwear [5][6][7][8][9]. A major concern is the possible incorrect or overdiagnosis of the condition.…”