Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Morton’s Neuroma

SYMPTOMS

Sharp radiating exercise-induced pain or dysaestesia between two metatarsal bones, most often between MT III and MT IV, without obvious preceding trauma. There are often bilateral symptoms. Usually it occurs in adults and particularly in middleaged recreational athletes who wear tight shoes.

AETIOLOGY

This syndrome is caused by entrapment of an inter-digital nerve between two metatarsal bones arising from a local neuroma or synovitis.

CLINICAL FINDINGS

There is distinct tenderness on palpation and a positive Tinel’s sign. Squeeze test is positive. Squeezing the toes together while holding the metatarsals parallel causes a typical local sharp pain reaction.

INVESTIGATIONS

Injection of 1-2 ml of local anaesthetic around the tender spot gives immediate pain relief. MRI can confirm the diagnosis and its cause.

TREATMENT

Initially try orthotics to support and lift the anterior foot arch. NSAID or local cortisone injections can give short-term relief. Surgery for excision of the neuroma is indicated in severe cases and shows excellent outcomes. However, the patient will then lose sensation in the area distal to the neuroma, which could be slightly disabling. Surgery is done as a day case and full weight bearing is often allowed within two to four weeks.

REFERRALS

Refer to podiatrist or physiotherapist for mild symptoms and to orthopaedic surgeon if the symptoms are severe or progressing.

EXERCISE PRESCRIPTION

Rest will not help so allow all kinds of sporting activities using well-fitting shoes.

DIFFERENTIAL DIAGNOSES

Stress fracture of metatarsal with synovitis.

EVALUATION OF TREATMENT OUTCOMES

Monitor a decrease of clinical symptoms and signs. Tinel’s sign and Squeeze test should be negative.

PROGNOSIS

Good-Fair. The pain, which disappears with treatment, is replaced with lack of sensation, which some athletes retrospectively feel is worse than the initial pain.

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