Morton's neuroma differential diagnosis: Difference between revisions

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Revision as of 22:13, 17 June 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2]

Overview

Morton's neuroma must be differentiated from other causes of pain in the forefoot such as capsulitis, intermetatarsal bursitis, arthritis of intermetatarsal joints, calluses, stress fractures, and Freiberg's disease.

Differentiating Morton's Neuroma from other Diseases

  • Morton's neuroma must be differentiated from other causes of pain in the forefoot because too often all forefoot pain is categorized as neuroma
  • Since a neuroma is a soft tissue condition, an MRI should be helpful in diagnosis, however, often an MRI will be inconclusive for neuroma even though a neuroma exists
  • Other conditions to consider are:
    • Metatarsophalangeal joint capsulitis/metatarsalgia
    • Intermetatarsal bursitis between the third and fourth metatarsal bones will also give neuroma type symptoms because it too puts pressure on the nerve
    • Inflammatory arthritis of joints that join the toes to the foot
    • Calluses
    • Metatarsal stress fracture
    • Freiberg's disease
    • Osteomyelitis
    • Localized vasculitis
    • Ischemia
    • Tarsal tunnel syndrome
    • Rheumatoid arthritis
    • Peripheral neuritis
    • Synovitis
    • Tendonitis
    • Avascular necrosis
Differentiating Morton's neuroma from other diseases
Disease/Condition Underlying Etiology Pathophysiology Clinical presentation Other associated features
Morton's neuroma

On gross pathology, characteristic findings of morton's neuroma, include:

Symptoms of morton's neuroma include:

Usually located at the following sites:

(first toe is usually not involved)

Metatarsophalangeal joint capsulitis/Metatarsalgia
  • Abnormal foot mechanics (putting excessive amount of weight bearing pressure on the ball of the foot beneath the toe joint)
  • Repetitive foot motion exerting pressure on the ball of foot resulting in connective tissue degeneration
  • High level of activity
  • Tight Achilles tendon
  • Severe foot deformities such as:
    • Bunion
    • Hammertoe
  • Second toe longer than the big toe
  • Structurally unstable high arch of foot
  • Prominent metatarsal heads
  • Tight toe extensor muscles
  • Weak toe flexor muscles
  • Hypermobile first foot bone
  • Improper fitting footwear (women’s dress shoes, other restrictive footwear with narrow toe box)
  • High heels
  • High impact activities/sports without proper footwear/orthotics such as track & field running, tennis, football, baseball, & soccer
  • Older age (thinning of foot fat pad leads to more susceptibility to pain in the ball of the foot)
  • Inflammation of capsule/ligaments that surround two bones, at the level of the joint (in this case, ligaments that attach the toe bone to the metatarsal bone)
  • Inflammation from this condition will put pressure on an otherwise healthy nerve and give neuroma type symptoms
  • Pain, particularly on the ball of the foot
  • Feeling like:
    • A ''marble'' in the shoe
    • A bunched up sock
    • Standing on a "pea''
  • Swelling at the base of the toe
  • Difficulty wearing shoes
  • Pain while walking barefoot
  • Crossover toe (end-stage of capsulitis)
  • Also referred to as ''ball-of-foot-pain''
  • Colloquially known as ''stone bruise''
  • Usually located under the 2nd, 3rd, & 4th metatarsal heads
Intermetatarsal bursitis
  • Trauma
  • Rheumatoid arthritis
  • Gout
  • Irritation & inflammation of intermetatarsal bursa
  • Between the third and fourth metatarsal bones will give neuroma type symptoms because it too puts pressure on the nerve
Inflammatory arthritis of metatarsophalangeal joints (join the toes to the foot)
Calluses
Metatarsal stress fracture
Freiberg's disease
Osteomyelitis
Localized vasculitis
Tarsal tunnel syndrome
Rheumatoid arthritis
Peripheral neuritis
Synovitis
Tendonitis
Avascular necrosis

References


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