Clinical features

Moreton's metatarsalgia is more common in women, with a peak incidence in the fifth decade (1).

Symptoms reported by the patient are usually characteristic for this condition:

• there is sharp, intermittent attacks of pain in the forefoot during walking which may often radiate into the related toes
  • pain is aggravated by wearing tight-fitting, high-heeled shoes and relieved by resting and removing shoes.
• pain often is localized at the plantar aspect of the respective intermetatarsal space, but it can radiate into the adjacent toes.
• patients may describe the pain as:
  • burning
  • stabbing
  • tingling with electric sensations
• occasionally diminished sensation may be the only symptom (1)
• some patients describe the sensation as walking on a stone or marble or walking on a rolled-up or wrinkled sock
• prolonged walking may result in pain shooting up the foot or leg, causing cramps.
• numbness between the toes is present in less than half of the patients
• there is localized tenderness over the site of the neuroma (1,2,3,4,)

Small lesion (< 6 mm) can cause symptoms consistent with larger lesions (5).

Reference:

• (1) Hassouna H, Singh D. Morton's metatarsalgia: pathogenesis, aetiology and current management. Acta Orthop Belg. 2005;71(6):646-55
• (2) Rout R at al. Morton's neuroma: diagnostic accuracy, effect on treatment time and costs of direct referral to ultrasound by primary care physicians. Qual Prim Care. 2009;17(4):277-82
• (3) Munir U, Morgan S. Morton Neuroma. [Updated 2017 Nov 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan
• (4) Thomas JL et al.Diagnosis and treatment of forefoot disorders. Section 3. Morton's intermetatarsal neuroma. J Foot Ankle Surg. 2009 Mar-Apr;48(2):251-6.
• (5) Sharp RJ et al. The role of MRI and ultrasound imaging in Morton's neuroma and the effect of size of lesion on symptoms. J Bone Joint Surg Br. 2003;85(7):999-1005