Intermetatarsal (Morton’s) Neuroma

Ovid: 5-Minute Sports Medicine Consult, The

Intermetatarsal (Morton's) Neuroma
Alan Zakaria
Robert B. Kiningham
  • An inflammatory fibrosing process of the interdigital nerve characterized by pain on the plantar surface of the foot
  • Most commonly occurs between the heads of the 3rd and 4th metatarsals, although may also involve the 2nd and 3rd intermetatarsal space
  • Occurs just before the nerve bifurcates at the metatarsal area to innervate sides of 2 adjacent toes
  • Usually unilateral symptoms
  • Occurs more often in women than men
  • Found in kickboxers, ballet dancers, and runners
  • Caused by nerve thickening from repetitive dorsiflexion of the toes, causing microtrauma to the nerve as it is compressed either under the transverse metatarsal ligament or by an inflamed intermetatarsal bursa (1)
  • The repetitive trauma causes swelling of the plantar digital nerve that pathologically resembles other nerve entrapment syndromes
Physical Exam
  • Intermittent, episodic pain, usually on the plantar surface of the foot between the 3rd and 4th metatarsals
  • Forefoot pain radiating to the affected interspace, toes, and ankle (1)[C]
  • Paresthesias in the toes and interdigital space are common (1)[C].
  • Pain exacerbated with exercise and relieved with rest
  • Tenderness to palpation on the plantar surface of the foot, usually between the 3rd and 4th metatarsals
  • Mulder's click: Audible, painful click after compressing the metatarsal heads and releasing the forefoot (1)[C]
  • No weakness noted on strength testing of the foot
Diagnostic Tests & Interpretation
  • Primarily a clinical diagnosis
  • Imaging usually not needed
  • X-ray imaging can be used to exclude other causes of foot pain.
  • Electromyography and nerve conduction studies are not helpful.
  • MRI may show neuroma and edema surrounding the interdigital nerve (2)[A].
Differential Diagnosis
  • Metatarsalgia
  • Metatarsal stress fracture
  • Ganglion cyst
  • Neuropathies (diabetic, alcoholic, toxic, nutritional)
  • Freiberg's disease (osteochondrosis of the head of the metatarsal in teenagers)


355.6 Lesion of plantar nerve

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