Isolated reports showed that up to a third of patients are asymptomatic [4], but in many individuals, pain originating from the nerves of the affected foot is present. The pain may be extreme enough to prevent patients from walking [1].

• Toe Pain

  Morton's neuroma is most commonly found in the forefoot with symptoms between the third and fourth toes. Pain is limited to the plantar (bottom) forefoot. [myfootshop.com]

  These conditions all produce localised forefoot pain under the bottom of the toes. [spinalandsportscare.com.au]

  The patient complains of pain in the third web space between the third and fourth metatarsal, radiating to the third and fourth toes. Pain is worse with walking, weight bearing and with wearing narrow toed shoes. [youtube.com]

  […] of the third and fourth toes Pain has typically been present for weeks to years Usually exacerbated by exercise, and relieved by rest Lists Tumors of Peripheral Nerves Granular cell tumor Inflammatory pseudotumor Localized interdigital neuroma (Morton [surgpathcriteria.stanford.edu]

  Signs and Symptoms Numbness in toes Tingling sensation in the toes Immense burning pain in the ball of your foot moving towards your toes Pain worsens with activity Little to no pain early in the day, but you may start to feel it as the day progresses [footlogics-orthotics.com]

• Pathologist

  The surgical specimens were retrieved and reviewed by a pathologist in 21 cases. [ncbi.nlm.nih.gov]

• Hyperkeratosis

  Initial treatment = non-surgical Sensible footwear padding, orthotics, shoe insoles, Occasionally debridement of assoc. hyperkeratosis, steroid injection if bursitis Rarely ortho referral for - tenotomy / tendon lengthening / capsular release / phalangeal [emed.ie]

  Subluxation of a metatarsophalangeal joint • Localized metatarsal equinus • Generalized joint hypermobility Non-functional metatarsalgia (forefoot pain due to forefoot, foot or limb pathology or systemic disease) Soft-tissue pathologies • Focal plantar hyperkeratosis [medical-dictionary.thefreedictionary.com]

  The following is a short list of possible diseases: Soft-tissue diseases • Hyperkeratosis of the focal plantar • One or more connective tissue pathologies such as plantar fibromatosis, plate rupture etc. • One or more synovial pathologies such as nodules [runnerclick.com]

• Plantar Hyperkeratosis

  hyperkeratosis • Connective tissue pathology, e.g. plantar fibromatosis, plantar plate rupture • Synovial pathology, e.g. ganglion, adventitious bursitis, capsulitis, gouty tophus, rheumatoid bursae and nodules • Vascular pathology, e.g. ischaemia, venous [medical-dictionary.thefreedictionary.com]

• Metatarsalgia

  Morton's metatarsalgia. Med J August 1940;514-5. Jeff Jeffrey A. Oster, DPM Medical Director Myfootshop.com LinkedIn l Facebook [myfootshop.com]

  [meta- + G. algos, pain] metatarsalgia /meta·tar·sal·gia/ ( -tahr-sal´jah ) pain and tenderness in the metatarsal region. metatarsalgia (mĕt′ə-tär-săl′jə) n. [medical-dictionary.thefreedictionary.com]

  To confirm Morton's metatarsalgia, however, either ultrasonography or MRI can be performed and both procedures show very good results. [symptoma.com]

  How to Assess Morton's Neuroma or Morton's Metatarsalgia or Plantar Neuroma? A common and simple test can be used to assess Morton's Neuroma or Morton's Metatarsalgia or Plantar Neuroma. [epainassist.com]

• Foot Pain

  There are many common causes of foot pains, such as blisters and corns. There are also less common causes of foot pain, such as sciatica and osteomyelitis. Foot pain may cause unsteady gait and/or limping. [medicinenet.com]

  & Heel Pain Relief Products as They Make Top Gifts, - Great Value, Metatarsalagia Foot Pain, Save Up to 20% Extra on Multiple Orders Buy Metatarsal Pads for Women or Men's Feet - Comfortable Ball of Foot Pads for Mortons Neuroma or Metatarsalgia Pain [destinationpupg.com]

  LifeLux Ball Of Foot Cushions Pain Relief Kit was designed to help relieve a variety of foot issues including Metatarsalgia, Bursitis, Morton's neuroma, hammertoe deformity, ankle pain, painful aches, tendonitis and diabetic foot pain. [aptoco.com]

  Our Oakville Chiropractors treat all types of foot pain, more often then not, if you have a sharp stabbing pain in the base of you toes and forefoot its Mortons Nueroma. [glenabbeychiro.com]

• Foot Deformity

  Ill-fitting high heels or shoes that add pressure to the toe or foot -Jogging, running or any sport that involves constant impact to the foot -Flat feet, bunions, and any other foot deformities Morton’s neuroma is a very treatable condition. [pheetnewz.com]

  In some cases, wearing supportive shoes can help when this is the cause of the condition, but more aggressive treatments may be necessary to correct the foot deformity. [mortonsneuroma.com]

  deformities: bunions, hammer toes, flat feet, excessive flexibility Metatarsalgia Metatarsal stress fracture Capsulitis Synovitis Stress fracture Tendinitis Degenerative arthritis Bursitis Lumbar radiculopathy Freiburg’s disease: osteochondritis of the [accessphysiotherapy.mhmedical.com]

  Factors that contribute to Morton’s neuroma include high-impact sports, foot deformities, and choice of footwear, especially high heels or tight shoes (that might be required in certain sports) that put pressure on the toes. [okanaganacupuncture.com]

• Numbness of the Feet

  Some patients also report lack of sensation and numbness in their feet, while other describe the pain as similar to walking with a pebble in their shoe. [news-medical.net]

• Foot Disease

  Our purpose is to describe and illustrate, by means of magnetic resonance imaging, main diseases causing metatarsalgia. Keywords: Metatarsalgia; Foot diseases; Arthropathy; Magnetic resonance imaging. [scielo.br]

• Paresthesia

  Initially, mild pain caused by wearing narrow shoes can worsen and become lancinating, sometimes with paresthesias and/or a foreign body sensation. [msdmanuals.com]

  The patient may complain of paresthesia at the bottom of the web space. Examination: •Squeezing the metatarsals together can cause shooting pain that will go into the third and fourth toes. •The neuroma may be palpable. [youtube.com]

  Abstract : Plantar interdigital neuroma, also called Morton neuroma, neuralgia, or metatarsalgia, is a perineural fibrosis that induces severe intermittent pain and paresthesia, most frequently between the third and fourth metatarsal heads. [hal.archives-ouvertes.fr]

  […] endo-perineural fibrosis and hyaline degeneration of interdigital nerve endonevrium The diagnosis is basically clinical: Burning pain at the level of a intermetatarsal web space that may radiate to the fingers or back along the midfoot / leg ± Associated with paresthesias [epos.myesr.org]

The diagnosis should be rather easily made, as a compression test of the foot can reveal the painful site and determine the affected web space [2]. To confirm Morton's metatarsalgia, however, either ultrasonography or MRI can be performed and both procedures show very good results [5].

Modification of footwear, injection of corticosteroids or local anesthetics and use of custom-made orthoses are conservative measures currently used to relieve symptoms of metatarsalgia [3] [6], but in severe cases, surgical neurectomy (with a maximal success rate of 83%) may be necessary to alleviate pain [3]. A significant difference between non-surgical and surgical approaches was not observed, however [1], and an individualized approach should be favored.

Patients present with a varying severity of symptoms, but pain may be so severe that is can markedly impair the quality of life, which is why early recognition of the disorder and appropriate treatment is necessary.

The exact cause of Morton's metatarsalgia remains unknown, but various conditions have been described, including ischemia, bursitis, and chronic trauma [3]. The term Morton's neuroma is often used to erroneously suggest a neoplastic origin of the condition, but histological examinations have revealed the presence of inflammatory tissue and perineural fibrosis [6], implicating that other events are responsible for its development.

A significant predilection toward middle-aged women was observed, presumably due to using inadequate footwear that induces substantial anatomical malformations of the foot [2] [6]. The exact prevalence rates in the population are unknown.

Mechanically-induced neuropathy, occurring on the grounds of substantial disruption of the normal foot physiology by improper footwear, is the most probable pathogenesis model [2].

Wearing appropriate footwear that provides comfort and maintains a regular anatomical position of the foot may be recommended as a preventive strategy.

Morton's metatarsalgia (also known as Morton's neuroma) is considered to be a mechanically-induced neuropathy of the foot, most likely involving the third digital nerve of the toes [1] [2]. The exact cause, however, is yet to be determined, as chronic trauma, ischemia and bursitis have been described in the pathogenesis as well [3]. The condition is most prevalent in middle-aged women wearing high heels, supporting the fact that mechanically-induced damage through wear of fashion shoes that are not in accordance with the physiological position of the foot results in this condition [2]. The clinical presentation ranges from the presence of few symptoms to a severely debilitating pain that impairs normal walking [4] [5]. A physical examination supported by ultrasonography or magnetic resonance imaging (MRI) is sufficient to make the diagnosis [3] [5]. Footwear modifications, use of orthoses, steroids or local anesthetics are conservative measures described in therapy [6], whereas neurectomy may be performed if all other modalities fail [3].

Morton's metatarsalgia is a condition that denotes the appearance of pain in the middle aspect of the foot, most commonly as a result of inadequate footwear and subsequent nerve compression and injury. The fact that the condition is most prevalent in middle-aged women who wear shoes with high heels that disrupt the normal anatomy of the foot, further supporting this theory. The exact cause and mechanism of disease, however, is yet to be determined, as other conditions such as bursitis, ischemia and trauma have been associated with Morton's metatarsalgia. Foot pain is the principal symptom and some patients may report excruciating pain that reduces their ability to walk normally. The diagnosis should be made during a regular physical examination, but either ultrasonography or magnetic resonance imaging can be used for confirmation. Treatment initially consists of conservative measures - footwear modification, use of local anesthetics and orthoses, while surgical procedures to remove damaged nerve tissue are performed as a last resort.

1. Thomson CE, Gibson JN, Martin D. Interventions for the treatment of Morton's neuroma. Cochrane Database Syst Rev. 2004;(3):CD003118.
2. Wu KK. Morton neuroma and metatarsalgia. Curr Opin Rheumatol. 2000;12(2):131-142.
3. Hassouna H, Singh D. Morton's metatarsalgia: pathogenesis, aetiology and current management. Acta Orthop Belg. 2005;71(6):646-655.
4. Bencardino J, Rosenberg ZS, Beltran J, Liu X, Marty-Delfaut E. Morton's neuroma: is it always symptomatic? AJR Am J Roentgenol. 2000;175(3):649-653.
5. Bignotti B, Signori A, Sormani MP, Molfetta L, Martinoli C, Tagliafico A. Ultrasound versus magnetic resonance imaging for Morton neuroma: systematic review and meta-analysis. Eur Radiol. 2015;25(8):2254-2262.
6. Jain S, Mannan K. The diagnosis and management of Morton's neuroma: a literature review. Foot Ankle Spec. 2013;6(4):307-317.