Morton's neuroma differential diagnosis

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:
  • Capsulitis
  • Intermetatarsal bursitis between the third and fourth metatarsal bones will also give neuroma type symptoms because it too puts pressure on the nerve
  • Arthritis of joints that join the toes to the foot
  • Calluses
  • Stress fractures
  • Freiberg's disease

Differentiating Morton's neuroma from other diseases

Disease/Condition	Underlying Etiology	Pathophysiology	Clinical presentation	Other associated features
Morton's neuroma
Capsulitis	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 Severe bunion deformity Second toe longer than the big toe Structurally unstable arch of the foot Tight calf muscles	Inflammation of ligaments that surrounds 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 of a marble in the shoe or a bunched up sock) Swelling at the base of the toe Difficulty wearing shoes Pain while walking barefoot Crossover toe (end-stage of capsulitis)
Intermetatarsal bursitis		Between the third and fourth metatarsal bones will give neuroma type symptoms because it too puts pressure on the nerve
Arthritis of metatarsophalangeal joints (join the toes to the foot)
Calluses
Stress fractures
Freiberg's disease

References

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