Physical Medicine and Rehabilitation for Morton Neuroma Differential Diagnoses

Updated: May 26, 2020
  • Author: Kevin Berry, MD; Chief Editor: Dean H Hommer, MD  more...
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DDx

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