eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Morton Neuroma: Follow-up

Author: Kevin Berry, MD, Resident Physician, Physical Medicine and Rehabilitation Department, University of Colorado Hospital
Coauthor(s): Peter Gonzalez, MD, Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine; Richard G Bowman II, MD, Rehabilitation and Electrodiagnostic Director, Physical Medicine and Rehabilitation, Pain Management, The Center for Pain Relief
Contributor Information and Disclosures

Updated: May 26, 2009

Follow-up

Deterrence/Prevention:

  • General prevention includes ensuring that shoes fit properly. Recommend that the patient wear well-padded, low-heeled shoes with a wide toe box. No other preventative techniques are recommended.

Complications:

  • Chronic pain may develop when treatment is unsuccessful for patients with Morton's neuroma. Postoperative complications, such as dysesthesias, are possible when surgery is performed to remove the neuroma. Possible complications following corticosteroid injections may include plantar fat pad necrosis and transient numbness of the toes.

Prognosis:

  • Prognosis for recovery is good with conservative treatment; however, patients still may require surgical intervention. Some patients who undergo surgery report a recurrence rate of as high as 50%.

Patient Education:

  • Patients should be well informed about proper footwear.

Miscellaneous

Medicolegal Pitfalls

  • 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
    • Hammer toe
    • 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
 


More on Morton Neuroma

Overview: Morton Neuroma
Differential Diagnoses & Workup: Morton Neuroma
Treatment & Medication: Morton Neuroma
Follow-up: Morton Neuroma
Multimedia: Morton Neuroma
References
Further Reading
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References

  1. Morton TG. Peculiar painful affection of fourth metatarsophalangeal articulation. Am J Med Sci. 1876;71:37.

  2. Kim JY, Choi JH, Park J, et al. An anatomical study of Morton's interdigital neuroma: the relationship between the occurring site and the deep transverse metatarsal ligament (DTML). Foot Ankle Int. Sep 2007;28(9):1007-10. [Medline].

  3. O'Connor FG, Wilder RP, Nirschl R. Foot Injuries in the Runner. In:Textbook of Running Medicine. New York: McGraw-Hill; 2001;258-260.

  4. Lee MJ, Kim S, Huh YM, Song HT, Lee SA, Lee JW, et al. Morton neuroma: evaluated with ultrasonography and MR imaging. Korean J Radiol. Mar-Apr 2007;8(2):148-55. [Medline].

  5. Zanetti M, Weishaupt D. MR imaging of the forefoot: Morton neuroma and differential diagnoses. Semin Musculoskelet Radiol. Sep 2005;9(3):175-86.

  6. Akermark C, Saartok T, Zuber Z. A prospective 2-year follow-up study of plantar incisions in the treatment of primary intermetatarsal neuromas (Morton's neuroma). Foot Ankle Surg. 2008;14(2):67-73. [Medline].

  7. Monacelli G, Cascioli I, Prezzemolo G, Spagnoli A, Irace S. [Surgical treatment of Morton's neuroma: our experience and literature review]. Clin Ter. May-Jun 2008;159(3):165-7. [Medline].

  8. Valente M, Crucil M, Alecci V. Operative treatment of interdigital Morton's neuroma. Chir Organi Mov. May 2008;92(1):39-43. [Medline].

  9. Villas C, Florez B, Alfonso M. Neurectomy versus neurolysis for Morton's neuroma. Foot Ankle Int. Jun 2008;29(6):578-80. [Medline].

  10. Title CI, Schon LC. Morton neuroma: primary and secondary neurectomy. J Am Acad Orthop Surg. Sep 2008;16(9):550-7. [Medline].

  11. Markovic M, Crichton K, Read JW, et al. Effectiveness of ultrasound-guided corticosteroid injection in the treatment of Morton's neuroma. Foot Ankle Int. May 2008;29(5):483-7. [Medline].

  12. Betts LO. Morton's Metatarsalgia. Med J Aust. 1940;1:514.

  13. Clanton TO, Butler JE, Eggert A. Injuries to the metatarsophalangeal joints in athletes. Foot Ankle. Dec 1986;7(3):162-76. [Medline].

  14. Cyriax J. Diagnosis of soft tissue lesions.In: Textbook of Orthopaedic Medicine. 8th ed. Philadelphia, Pa:. The Curtis Center;1982.

  15. Guiloff RJ. Carbamazepine in Morton''s neuralgia. Br Med J. Oct 13 1979;2(6195):904. [Medline].

  16. Jahss MH, Kummer F. Non-inflammatory synovitis of the second metatarsophalangeal joint and its surgical management. Paper read at: 16th Annual Meeting of American Orthopaedic Foot Ankle Society, New Orleans, La. February 1986.

  17. Logan PM, Janzen DL, O''Connell JX, et al. Magnetic resonance imaging and histopathologic appearances of benign soft-tissue masses of the foot. Can Assoc Radiol J. Feb 1996;47(1):36-43. [Medline].

  18. Mizel MS, Miller RA, Scioli MW. Orthopaedic knowledge update. In: Foot and Ankle. Rosemont, Ill:. American Academy of Orthopaedic Surgeons;1998.

  19. Snyder RK. In: Essentials of Musculoskeletal Care. Rosemont, Ill:. American Academy of Orthopedic Surgeons;1997.

  20. Terk MR, Kwong PK, Suthar M, et al. Morton neuroma: evaluation with MR imaging performed with contrast enhancement and fat suppression. Radiology. Oct 1993;189(1):239-41. [Medline].

  21. Vazquez-Abad D, Tian L, Monteon V, et al. CRI-EM is a human idiotype highly specific for scleroderma. Ann N Y Acad Sci. Apr 5 1997;815:512-5. [Medline].

  22. Wu KK. Morton neuroma and metatarsalgia. Curr Opin Rheumatol. Mar 2000;12(2):131-42. [Medline].

  23. Yocum LA. In: Clinics in Sports Medicine. Vol 7. Philadelphia, Pa:. WB Saunders Co;1988.

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Keywords

Morton neuroma, Morton's neuroma, neuroma, metatarsal, foot surgery, foot pain, feet pain, metatarsals, neuroma surgery, foot neuroma, neuromas, neuroma treatment, metatarsalgia, plantar nerve, interdigital nerve, Morton's metatarsalgia, interdigital neuroma, plantar neuroma, Morton metatarsalgia

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Contributor Information and Disclosures

Author

Kevin Berry, MD, Resident Physician, Physical Medicine and Rehabilitation Department, University of Colorado Hospital
Kevin Berry, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Medical Student Association/Foundation, and Illinois State Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Peter Gonzalez, MD, Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine
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, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

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.

Medical Editor

Robert J Kaplan, MD, James E Van Zandt VA Medical Center, Staff Physician, Department of Rehabilitation Medicine
Robert J Kaplan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, 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, and Association of Academic Physiatrists
Disclosure: allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
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