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Physical Medicine and Rehabilitation for Morton Neuroma Differential Diagnoses

  • Author: Kevin Berry, MD; Chief Editor: Consuelo T Lorenzo, MD  more...
 
Updated: Jan 11, 2016
 
 

Diagnostic Considerations

The most common condition misdiagnosed as Morton's neuroma is metatarsophalangeal (MTP) joint synovitis. When pain occurs in the third interspace, the clinician may misdiagnose the condition as Morton's neuroma instead of MTP synovitis, which may manifest very much like Morton's neuroma. MTP synovitis is distinguished from Morton's neuroma by subtle swelling around the joint, pain localized mainly within the joint, and pain with forced toe flexion. Palpation of the MTP joint is performed best with a pinching maneuver from the dorsal and plantar aspects of the joint to elicit tenderness of the joint. Other conditions often misdiagnosed as Morton's neuroma include the following:

  • Stress fracture of the neck of the metatarsal
  • Rheumatoid arthritis and other systemic arthritic conditions
  • Hammertoe
  • Metatarsalgia (ie, plantar tenderness over the metatarsal head)

Less common conditions that have overlapping symptoms with Morton's neuroma include the following:

  • Neoplasms
  • Metatarsal head osteonecrosis
  • Freiburg osteochondrosis
  • Ganglion cysts
  • Intermetatarsal bursal fluid collections
  • True neuromas
 
 
Contributor Information and Disclosures
Author

Kevin Berry, MD Physical Medicine and Rehabilitation Physician, Rehabilitation Options of Issaquah

Kevin Berry, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, International Spine Intervention Society

Disclosure: Nothing to disclose.

Coauthor(s)

Richard G Bowman, II, MD Rehabilitation and Electrodiagnostic Director, Physical Medicine and Rehabilitation, Pain Management, The Center for Pain Relief

Richard G Bowman, II, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Peter Gonzalez, MD Assistant Professor, Department of Physical Medicine and Rehabilitation, Eastern Virginia Medical School

Peter Gonzalez, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, Association of Academic Physiatrists

Disclosure: Received honoraria from Allergan for speaking and teaching.

Chief Editor

Consuelo T Lorenzo, MD Medical Director, Senior Products, Central North Region, Humana, Inc

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

References
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Plantar view showing the relationships between the metatarsal heads, the intermetatarsal ligament, and the neuroma.
Neurectomy: typical incision location.
Neurectomy: superficial exposure.
Neurectomy: deeper dissection.
Neuroma and adherent fibrofatty tissue.
 
 
 
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