MANUAL MINORS
Morton’s metatarsalgia, also known as Morton’s neuroma, is a painful condition of the foot that involves the thickening or irritation of one of the interdigital nerves, most commonly between the third and fourth metatarsals.
This results in pain, burning, numbness, or a “shock-like” sensation in the sole of the foot, often caused by repetitive nerve compression due to wearing tight footwear or engaging in high-impact activities such as running.
Diagnosis
Diagnosis is based on the patient’s clinical history, reporting pain between the toes, a burning sensation, or sharp stabs that worsen when walking, especially in tight shoes. On palpation, the physician may feel a “click” (Mulder’s sign) between the metatarsal bones when compressing the affected area. Magnetic resonance imaging (MRI) or ultrasound can help confirm the diagnosis by visualising the neuroma.
Differential Diagnosis
Condition | Key Difference |
|---|---|
Mechanical metatarsalgia | Pain in the forefoot due to overload, without a neuropathic component. |
Plantar fasciitis | Pain in the sole, closer to the heel, without interdigital nerve involvement. |
Metatarsal stress fracture | Localised pain in the metatarsal, with radiological evidence of fracture. |
Foot arthritis | Joint pain accompanied by stiffness, without localised nerve irritation. |
Emergency Management
Initial management focuses on relieving pressure on the affected nerve. This can be achieved by applying ice and taking analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs).
It is recommended to wear comfortable shoes and avoid activities that worsen the symptoms, such as walking in tight or high-heeled shoes. Orthotic insoles with metatarsal pads may provide immediate relief.
Definitive Treatment
Definitive treatment varies according to the severity of the condition. For mild to moderate cases, conservative management includes using orthotic insoles, changing footwear, and physiotherapy. If symptoms persist, corticosteroid injections can be administered to reduce inflammation and pain. In severe or treatment-resistant cases, surgery to remove the neuroma or release the affected nerve is considered, with good outcomes in most cases.
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