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Common sites for Morton's neuromas

Morton's Neuroma is a painful condition of the forefoot that is caused by the entrapment of the common intermetatarsal nerve as it passes through the forefoot to the toes. Morton's Neuroma was first described by Dr. Morton, a Viennese physician, in 1876.
Where are most Morton's neuromas found?

A) In the tarsal tunnel
B) At the first metatarsal phalangeal joint
C) The second and third interdigital space
D) At the attachment of the plantar fascia
E) At the head of the fifth metatarsal

Answer and Discussion

The answer is C.
The interdigital spaces of the foot are common sites for painful neuromas, a condition termed Morton's neuroma. The second and third common digital branches of the medial plantar nerve are the most frequent sites for development of interdigital neuromas. Morton's neuromas develop as a result of chronic trauma and repetitive stress, as occurs in persons wearing tight-fitting or high-heeled shoes. Pain and paresthesias are usually mild at onset and are located in the interdigital space of the affected nerve. In some cases, the interdigital space between the affected toes may be widened as a result of an associated ganglion or synovial cyst. Pain is noted in the affected interdigital space when the metatarsal heads of the foot are squeezed together. Injection with 1% lidocaine (Xylocaine) can assist in confirming the diagnosis.

The symptoms of Morton's neuroma include the following;
  • A dull achy sensation in the forefoot, usually between the 3rd and 4th toes.
  • Pain that increased with the time a person spends on their feet, particularly in high heels and narrow fitting shoes.
  • Pain that is not relieved by rest. Neuroma pain takes several minutes to hours to subside.
  • Numbness of the 3rd and 4th toes.
  • A sensation of walking on something, such as a bunched up sock
  • .Occasionally, a snapping sensation or electrical shock sensation (Muldier's Sign).
The digital nerve(1) running in the narrow space between the metatarsal bones where it splits into two(2) and where a Mortons Neuroma is usually found.

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