History

Patients who have Morton neuroma (also referred to as interdigital neuroma or interdigital neuritis) typically present with pain and paresthesia localized to one interspace of the forefoot with radiation to the involved toes. The symptoms may wax and wane over many years and are exacerbated with compressive shoewear. Relief is common when the shoes are removed and the area is massaged.^[15]

Physical Examination

A provocative examination (see the image below) involves manually compressing the forefoot and simultaneously palpating the affected web space between the fingers of the other hand. The compression may result in the Mulder sign, which is a painful and palpable click that reproduces the symptoms.^[16]

Image demonstrates key provocative physical examination maneuver: simultaneous forefoot compression coupled with intermetatarsal space compression.

View Media Gallery

Workup

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Media Gallery

Plantar view showing relationships between metatarsal heads, intermetatarsal ligament, and neuroma.
Image demonstrates key provocative physical examination maneuver: simultaneous forefoot compression coupled with intermetatarsal space compression.
Histopathology reveals nerve fibers and pacinian corpuscles entrapped within fibromyxoid connective tissue.
Surgery for Morton neuroma. Dorsal incision.
Surgery for Morton neuroma. Superficial exposure.
Surgery for Morton neuroma. Deeper dissection.
Surgery for Morton neuroma. Neuroma and adherent fibrofatty tissue.
Surgery for Morton neuroma. Distal plantar transverse incision.
Surgery for Morton neuroma. Plantar longitudinal incision.

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Author

Lyle T Jackson, MD Orthopedic Surgeon, Foot and Ankle Surgery, Slocum Center for Orthopedics and Sports Medicine

Lyle T Jackson, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society

Disclosure: IINDEPENDENT CONTRACTOR - EDITOR FOR FOOT AND ANKLE TOPICS for: DYNAMED, EBSCO PUBLISHING INC.

Coauthor(s)

Thomas M Schaller, MD Orthopedic Trauma Surgeon, Steadman Hawkins Clinic of the Carolinas

Thomas M Schaller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, AO Foundation, Orthopaedic Trauma Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Smith-Nephew<br/>Received income in an amount equal to or greater than $250 from: smith nephew.

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.

Chief Editor

Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS Professor, Department of Orthopedic Surgery, Chief, Division of Foot and Ankle Surgery, Director, Foot and Ankle Fellowship Program, Department of Orthopedic Surgery, University of Texas Medical Branch School of Medicine

Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma Association, Texas Orthopaedic Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Styker.

Additional Contributors

Heidi M Stephens, MD, MBA Associate Professor, Department of Surgery, Division of Orthopedic Surgery, University of South Florida College of Medicine; Courtesy Joint Associate Professor, Department of Environmental and Occupational Health, University of South Florida College of Public Health

Heidi M Stephens, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, Florida Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor, Patrick L. O'Connor, MD, to the development and writing of this article.

Sections Surgery for Morton (Interdigital) Neuroma
Overview
Presentation
Workup
Treatment
Media Gallery
References

Surgery for Morton (Interdigital) Neuroma Clinical Presentation

History

Physical Examination

References

Tables

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