Morton's neuroma

From Wikipedia, the free encyclopedia

Morton's neuroma Classification and external resources
The plantar nerves.
ICD-10	G57.6
ICD-9	355.6
DiseasesDB	8356
eMedicine	orthoped/623  pmr/81 radio/882

Morton's neuroma (also known as Morton's metatarsalgia, Morton's neuralgia, plantar neuroma and intermetatarsal neuroma) is a benign neuroma of the interdigital plantar nerve.

This problem is characterised by numbness and pain, relieved by removing footwear.

Despite the name, the condition was first correctly described by a chiropodist named Durlacher^[1], and although it is labeled a "neuroma", many sources do not consider it a true tumor, but rather a perineural fibroma (fibrous tissue formation around nerve tissue).

Contents 1 Symptoms and signs 2 Diagnosis/differential diagnosis 3 In Popular Culture 4 References 5 External links

[edit] Symptoms and signs

Symptoms include: pain on weight bearing, frequently after only a short time; the pain is felt as a shooting pain affecting the contiguous halves of two toes. Burning, numbness and parasthesia may also be experienced. Classically the 3rd digital space between the 3rd and 4th toes is affected, but the condition can occasionally occur in the 2nd and 3rd interdigital space. The pain is caused by pressure on the enlarged section of nerve where it passes between the metatarsal heads, and is squeezed between them. The first toe is usually not involved. Neuroma in the 4th/5th interdigital space is described, but is extremely rare.

[edit] Diagnosis/differential diagnosis

Negative signs include no obvious deformities, erythema, signs of inflammation or limitation of movement. Direct pressure between the metatarsal heads will replicate the symptoms, as will compression of the forefoot between the finger and thumb so as to compress the transverse arch of the foot. This is referred to as Mulder’s Sign.

There are other causes of pain in the forefoot. Too often all forefoot pain is categorized as neuroma. Other conditions to consider are capsulitis, which is an inflammation of ligaments that surrounds two bones, at the level of the joint. In this case it would be the ligaments that attach the phalynx (bone of the toe) to the metatarsal bone. Inflammation from this condition will put pressure on an otherwise healthy nerve and give neuroma type symptoms. Additionally, an intermetatarsal bursitis between the third and fourth metatarsal bones will also give neuroma type symptoms because it too puts pressure on the nerve. Freiberg's disease, which is an osteochondritis of the metatarsal head, causes pain on weight bearing or compression.

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.

[edit] In Popular Culture

Dorothy Zbornak has surgery for Morton's neuroma in the first season The Golden Girls episode "The Operation."

[edit] References

1. ^ Morton's Neuroma: Interdigital Perineural Fibrosis - Wheeless' Textbook of Orthopaedics

[edit] External links

• Overview at Mayo Clinic
• Podiatry Channel
• -664076278 at GPnotebook
• American Orthopaedic Foot and Ankle Society
• American Academy of Podiatric Sports Medicine

v • d • e Nervous system pathology, primarily PNS (G50-G99, 350-359) Nerve, nerve root and plexus disorders (neuropathy, radiculopathy, plexopathy) cranial nerve: V (Trigeminal neuralgia) - VII (Facial nerve paralysis, Bell's palsy, Melkersson-Rosenthal syndrome, Central seven) - XI (Accessory nerve disorder) nerve root and plexus: Brachial plexus lesion - Thoracic outlet syndrome - Phantom limb mononeuropathy: upper limb (Carpal tunnel syndrome, Ulnar nerve entrapment, Radial neuropathy) - Causalgia - lower limb (Meralgia paraesthetica, Tarsal tunnel syndrome, Morton's neuroma) - Mononeuritis multiplex Polyneuropathies and other disorders of the PNS hereditary motor and sensory neuropathy (Charcot-Marie-Tooth disease, Dejerine Sottas syndrome, Refsum's disease) Guillain-Barré syndrome - Alcoholic polyneuropathy Diseases of myoneural junction autoimmune: Myasthenia gravis - Lambert-Eaton myasthenic syndrome Diseases of muscle (myopathy)/ neuromuscular disease Muscular dystrophy myotonic (Myotonic dystrophy, Myotonia congenita, Thomsen disease, Neuromyotonia, Paramyotonia congenita) congenital myopathy (Centronuclear myopathy, Nemaline myopathy, Central core disease) Mitochondrial myopathy periodic paralysis: Hypokalemic - Hyperkalemic Dysautonomia/ Autonomic neuropathy Hereditary sensory and autonomic neuropathy (Familial dysautonomia) - Horner's syndrome - Multiple system atrophy (Shy-Drager syndrome, Olivopontocerebellar atrophy)