Knee / Ankle / Foot

Morton Neuralgia

Definition

Morton neuralgia is a neurological disorder due to a lesion or dysfunction of this nerve and is accompanied by pain and neurological deficits in region of the third plantar interdigital nerve of the foot.

Aetiology

Morton neuralgia is caused by compression of the nerve between the heads of the third and fourth metacarpal bones and the transverse ligament.

In addition, trauma and sagging forefeet can also be the cause of Morton neuralgia.

Due to longstanding irritation of the nerve, micro-traumata can occur, leading to nerve degeneration, fibrosis and neuroma formation. This neuroma formation can cause further damage and pain. It is more frequently seen in middle-aged females, due to excessive load on the forefoot, such as in walking on high heels.

Signs and symptoms

Patients with Morton neuralgia complain of pain, sensory loss, hyperalgesia and allodynia of the third toe. Walking and load on the forefoot provoke pain.

Diagnostics

Physical Examination

Morton's manoeuvre (compression of the metacarpal bones) is the neurological test of choice.

Additional Somatic Diagnostics

  • None
  • RAND-36 (quality of life)
  • VAS-Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Additional Psycho-cognitive Diagnostics

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis.  Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment consisting of various non-somatic treatments may be necessary.

Non-somatic Treatment

Somatic Treatment

Pharmacological treatment:

  • Tricyclic antidepressants
  • Anticonvulsives: carbamazepine, oxcarbazepine, gabapentine and pregabaline.

Other Treatments

Interventional Pain Treatment