Morton's neuroma pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [8]; Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[9]

Overview

Neuroma

Pathogenesis

• The pathogenesis of neuroma is characterized by neural degeneration with epineural and endoneural vascular hyalinization, and perineural fibrosis
• Morton neuroma is characterized by being located in the 3rd web-space, between 3rd and 4th metatarsal heads, or sometimes in the second or fourth interspaces
• On gross pathology, characteristic findings of neuroma, include:
  • Adherent fibrofatty tissue
  • Small, firm, oval, yellowish-white, slowly growing, palpable nodule on skin (no discoloration of skin on the top of nodule)
  • </=2cm in size
• On microscopic histopathological analysis, characteristic findings of neuroma, include:
  • Extensive fibrosis around and within the nerve
  • Digital artery
  • Thrombosis
  • Arterial thickening
• On histopathology, it is comprised of:
  • Degenerated/demyelinated axons
  • Vascular hyalinization
  • Fibrosis

H&E stain of Morton's neuroma, low magnification [1]

H&E stain of Morton's neuroma, very high magnification [6]

H&E stain of Morton's neuroma, High magnification [2]	H&E stain of Morton's neuroma, Intermediate magnification [3]	H&E stain of Morton's neuroma, Intermediate magnification [4]	H&E stain of Morton's neuroma, High magnification [5]
H&E stain of Morton's neuroma, Intermediate magnification [7]