What are the common clinical signs for Morton’s neuroma?
Persistent fore-foot pain is the most common complaint with Mortons neuroma but it may be so non-specific that morton neuroma can be easily misdiagnosed for many other medical and musculoskeletal conditions such as bursitis, arthritis, metatarsophalangeal (MTP) joint synovitis and tarsal tunnel syndrome.
Morton’s neuroma is one of the commonest and most frequently reported causes of fore-foot pain that can potentially lead to severe complications in poorly managed cases.
Common symptoms and clinical signs of Morton’s neuroma:
Research and clinical data indicates that Morton’s neuroma can be diagnosed with precision by careful history taking and thorough clinical examination in about 90 – 95% cases(1).
The classic clinical signs of Morton’s neuroma that are helpful in making the diagnosis of this condition are:
1. Pain in the third and fourth metatarsal space:
The involvement of first and second toe is rare (reported in less than 25-30% cases) due to anatomical as well as biomechanical factors(2). Morton’s neuroma occurs in one foot only in over 70% cases. In less than 30% cases, Morton’s neuroma may exist bilaterally(1).
2. Discomfort that may involve surrounding tissues:
The most characteristic symptom of Morton’s neuroma is the location and radiation of pain. In vast majority of cases, the pain originates in the mid-foot and radiates to the toe region. The pain or discomfort may range from a mild burning or tingling sensation to severe crushing/ aching pain (as if you are standing on a marble).
A ‘V’ distribution of pain is sometimes observed in Morton’s neuroma. You may feel localized numbness the metatarsal spaces AND in the affected toes. The severity of symptoms is highly variable.
3. Aggravation of symptoms:
Some individuals report pain after certain activities, while others may experience persistent pain/ numbness. However worsening of pain with certain physical activities is a clear sign that a medical consultation is necessary. In addition, you may experience worsening of pain and stiffness with prolong use of tight, constricting, or high-heeled shoes. Typically, the pain is relieved with rest and gently massaging of the affected area.
- Symeonidis, P. D., Iselin, L. D., Simmons, N., Fowler, S., Dracopoulos, G., & Stavrou, P. (2012). Prevalence of interdigital nerve enlargements in an asymptomatic population. Foot & ankle international, 33(7), 543-547.
- Pace, A., Scammell, B., & Dhar, S. (2010). The outcome of Morton’s neurectomy in the treatment of metatarsalgia. International orthopaedics, 34(4), 511-515.
Janet D. Pearl, MD, MSc is the Medical Director of The Center for Morton’s Neuroma and Complete Spine and Pain Care, an interventional and integrated Pain Management program located in Framingham, Massachusetts. Previously, Dr. Pearl was the Co-Director of the Pain Management Center at St. Elizabeth’s Medical Center, where she was also the Director of the Fellowship program. She is the former Director of a satellite pain center of the Brigham and Women’s Hospital, Pain Management Center, located at the HealthSouth Braintree Rehabilitation Hospital. Dr. Pearl held academic appointments at Harvard Medical School and Tufts Medical School. She serves on the Health Care Services Board of the Commonwealth of Massachusetts Department of Industrial Accidents since 2000 as one of its physician representatives and is Chair of the Committee on Pain Management.