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Morton's metatarsalgia

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Morton's metatarsalgia is a condition associated with a painful neuroma* on the digital nerve causing pain in the foot.

  • charcterised by perineural fibrosis and nerve degeneration due to repetitive irritation (1)
  • is thought to be due to irritation of the digital nerve caused by repeated trauma, ischemia or entrapment of the nerve (2)
  • occurs most frequently in women (F:M 8:1) aged 40-50 who wear high-heeled, pointed-toe shoes (3)

The neuroma occurs at the level of the metatarsal necks. The common digital nerve to the third/fourth metatarsal spaces is most often affected, although other interspaces can be involved (3).

The condition is characterised by sharp intermittent pain that shoots into the toes. However the pain is only felt when the patient wears shoes. There is localized tenderness over the site of the neuroma. There may be diminished sensation in the affected cleft. The patient will be very clear about relief of pain being achieved by removing the shoe and manipulating the foot (4).

X-rays are not useful, except to rule out other causes.

If there is no relief from symptomatic padding then the neuroma may be excised (note that this results in the toe being permanently numb, but pain is alleviated ) (4). Note that some would use cortisone injections as a treatment option for this condition (4).

* technically this condition is not a true neuroma , as a degenerative rather than a proliferative process is involved (4).