Morton's neuroma is a common foot condition that causes pain in the ball of the foot, usually between the third and fourth toes. It occurs when a nerve in the foot is compressed, causing pain, numbness, and tingling. Symptoms include pain that gets worse with walking and is relieved by removing shoes. Treatments may include shoe inserts, steroid injections, and surgery. The condition is often caused by wearing narrow, tight shoes that squeeze the toes together.

1. MORTON’S NEUROMA

2. Morton’s neuroma
Introduction of Morton’s neuroma:
o Morton’s neuroma (also known as Morton’s
metatarsalgia, Morton’s neuralgia, plantar
neuroma or intermetatarsal neuroma).
o In 1876, Morton describe a condition of pinching
of the leteral plantar nerve in the fourth and fifth
metatarsal heads of the foot.

3. Cont…….
Morton’s neuroma is a common problem,with
neuralgia affecting a single distal metatarsal inter-
spece,usally the third( affecting the third and
fourth toes) sometimes the second (affecting the
second and third toes),rearly others.

4. ….

5. Cont……..
Clinical Features:
 Patient complans of pain in the region of the third
and fourth metatarsals head.By walking pain
increases and decrease by rest.with the sensation of
walking on a pabble in the shoe, or the sock being
rucked –up undre the ball of the foot.
The pain is worse in tight footwear and often has to
be relife by removing the footwear and messaging
the foot.

6. Cont……
In morton’s metatarsalgia the pain is typically
reproduced by laterally compressing the forefoot.

7. Cont…………Activities that load the forefoot
(runing,jumping,dancing)exacrbat
e the condition,Which often
consists of severe forefoot pain and
then a reluctance to weight bear.
Mulder ‘s click When neuroma is squeezed
between the metatarsal heads a click is felt. This
is common in Women and is usally unilateral.

8. Cont…….
 Radiograph:
Pain X-ray,MRI of the fore foot especially the AP
view is recommended as a routine and helps to
rule out any bony problems.

9. Cont……..
Syndrome of morton’s neuroma:
o This is essentially an entrapment or compression
syndrome affecting one of the digital nerve.
o but secondary thickening of the nerve creates
the impression of a neuroma.
o An associated bursa
o Occupy a restricted space between the distal
metatarsals,and are pinched, especially if footwere
also laterally compresses the avaible space.

10. Cont……
Causes of morton’s neuroma:
Morton's neuroma are women who wear high-
heeled or narrow shoes. Conditions and situations
that can cause the bones to rub against a nerve
include:
High-heeled shoes -

11. Cont……
o High-arched feet.
o Flat feet
o Hammer toe
o Some high-impact sporting activities
o Injuries

12. Cont……..
Treatment of morton’s neuroma:
A stape- wise treatment programme is advisable-
Simple offloading of the metatarsal heads by using a
metatarsal dome insole and wider fitting shoes may
help.
lf symptoms don’t improve with these ,measures then a
steroid injection into the interspace will bring about
lasting relife in about 50 percent of cases.

13. Cont…..

14. Cont………
 Surgical intervention is often successful then the nerve
should be released by dividing the tight transvers
intermetatarsal ligament,this can be done through either a
dorsal longitudinal or planter incision, most surgeons will
also excise the thickened portion of the nerve.This
successful in about 90 percent of patient remaning 10
percent will continue to experiencevarying degrees of
discomfort.

15. Cont……..
Tarsal tunnel syndrome:
Pain and disturbance in the medial part of the
forefoot,unrelated to weight bearing, may be due
to compressionof the posterior tibial nerve behind
and below the medial nerve behind and below the
medial malleolus.Sometimes this is due to a space
–occupying lesion. ( e.g. ganglion,hemangioma or
varicosity).

16. Cont……
 This diagnosis is difficult to establish but nerve conduction
studies may show slowing of motor or sensory conduction.

17. Cont………..
Treatment:
To decompress the nerve it is exposed behind the
medial malleolus and followed into the sole,
sometimes it is trapped by the belly of adductor
hallucis arising more proximally than usual.
Summary:
Overview
Symptoms & Causes
Diagonosis & Treatment

18. Cont……….
Reference:
 http://www.mayoclinic.org/diseases-
conditions/mortons-neuroma/more-about/in-
depth/ssc-20202645
 TEXT BOOK: Essentials of Orthopedics ( Second
Edition) by- john Ebnezar
 TEXT BOOK: Apley’s System of Orthopaedics and
Fractures (Ninth Edition) by Louis Solomon—
david Warwick selvadurai Nayagam.