Diagnosis and treatment of Morton’s neuroma: the current state of the problem
https://doi.org/10.24412/1683-3295-2025-27-1-112-119
Abstract
Morton’s neuroma (the disease code according to the International Classification of Diseases of the 10th revision – G57.6) is an entrapment syndrome of the interdigital plantar nerve, which manifests as a neuropathic pain syndrome in the forefoot and functional disorders. Morton’s neuroma is the second most common among all tunnel neuropathies, which determines the importance of timely diagnosis and treatment of this disease.
The aim of this work – to increase the awareness of medical specialists about this pathology, a review of domestic and foreign scientific literature is presented, including basic information about it: the history of studying, current data on the prevalence, anatomical and histological characteristics and etiopathogenetic theories of the formation of Morton’s neuroma, the main methods of its diagnosis, treatment (conservative and surgical).
About the Authors
M. A. Razin
Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia; S.P. Botkin Moscow Multidisciplinary Scientific and Clinical Center, Moscow Healthcare Department
Russian Federation
Russian Federation
Mikhail A. Razin.
Bld. 1 2/1 Barricadnaya St., Moscow 125993; 5 2nd Botkinskiy Proezd, Moscow 125284
A. G. Fedyakov
Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia; S.P. Botkin Moscow Multidisciplinary Scientific and Clinical Center, Moscow Healthcare Department
Russian Federation
Russian Federation
Bld. 1 2/1 Barricadnaya St., Moscow 125993; 5 2nd Botkinskiy Proezd, Moscow 125284
A. V. Kuznetsov
Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia; S.P. Botkin Moscow Multidisciplinary Scientific and Clinical Center, Moscow Healthcare Department
Russian Federation
Russian Federation
Bld. 1 2/1 Barricadnaya St., Moscow 125993; 5 2nd Botkinskiy Proezd, Moscow 125284
A. V. Gorozhanin
Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia; S.P. Botkin Moscow Multidisciplinary Scientific and Clinical Center, Moscow Healthcare Department
Russian Federation
Russian Federation
Bld. 1 2/1 Barricadnaya St., Moscow 125993; 5 2nd Botkinskiy Proezd, Moscow 125284
O. N. Dreval
Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia
Russian Federation
Russian Federation
Bld. 1 2/1 Barricadnaya St., Moscow 125993
References
1. Hassouna H.Z. Morton’s neuroma: aetiology, pathogenesis and management. UK: LAP Lambert Academic Publishing, 2018.
2. Gougoulias N., Lampridis V., Sakellariou A. Morton’s interdigital neuroma: instructional review. EFORT Open Rev 2019;4(1):14–24. DOI: 10.1302/2058–5241.4.180025
3. Lu V.M., Puffer R.C., Everson M.C. et al. Treating Morton’s neuroma by injection, neurolysis, or neurectomy: a systematic review and meta-analysis of pain and satisfaction outcomes. Acta Neurochir (Wien) 2021;163(2):531–43. DOI: 10.1007/s00701-020-04241-9
4. Di Caprio F., Meringolo R., Shehab Eddine M., Ponziani L. Morton’s interdigital neuroma of the foot: literature revie. Foot Ankle Surg 2018;24(2):92–8. DOI: 10.1016/j.fas.2017.01.007
5. Lebedev I.A., Boldyreva Yu.V., Zakharchuk E.V. et al. Morton’s neuroma as a special case of tunnel neuropathy. Uralskiy Meditsinskiy zhurnal = Ural Medical Journal 2020;10(193):81–4. (In Russ.). DOI: 10.25694/URMJ.2020.10.16.1
6. Shpagin M.V., Yarikov A.V., Gorbatov R.О. et al. Morton’s neuroma: etiology, epidemiology, pathogenesis, clinical picture, diagnosis, and modern principles of treatment. Vestnik nevrologii, psichiatrii i neyrokhirurgii = Bulletin of Neurology, Psychiatry and Neurosurgery 2022;10:751–62. (In Russ.). DOI: 10.33920/med-01-2210-03
7. Boyko Yu.P., Fedyakov A.G., Shcherbin A.V., Razin M.A. Problems of organization of outpatient care for patients with carpal tunnel syndrome. Manager Zdravoohranenia = Healthcare Manager 2023;1:36–41. (In Russ.). DOI: 10.21045/1811-0185-2023-1-36-41
8. Larson E.E., Barrett S.L., Battiston B. et al. Accurate nomenclature for forefoot nerve entrapment: a historical perspective. J Am Podiatr Med Assoc 2005;95(3):298–306. DOI: 10.7547/0950298
9. Morton T.G. A peculiar and painful affection of the fourth metatarso-phalangeal articulation. Am J Med Sci 1876;71:37–45. DOI: 10.1097/00000441-187601000-00002
10. Hoadley A.E. Six cases of metatarsalgia. Chicago Med Rec 1893;5:32.
11. Betts L.O. Morton’s metatarsalgia: neuritis of the fourth digital nerve. Med J Aust 1940;1:514–5. DOI: 10.5694/j.1326-5377.1940.tb46191.x
12. Sandel R.K. Morton’s neuroma of the second toe. J Am Podiatry Assoc 1958;48(3):116–7.
13. Kasparek M., Schneider W. Surgical treatment of Morton’s neuroma: clinical results after open excision. Int Orthop 2013;37(9):1857–61. DOI: 10.1007/s00264-013-2002-6
14. Latinovic R., Gulliford M.C., Hughes R.A.C. Incidence of common compressive neuropathies in primary care. J Neurol Neurosurg Psychiatry 2006;77(2):263–5. DOI: 10.1136/jnnp.2005.066696
15. Valero J., Gallart J., González D. et al. Multiple interdigital neuromas: a retrospective study of 279 feet with 462 neuromas. J Foot Ankle Surg 2015;54(3):320–2. DOI: 10.1053/j.jfas.2014.05.011
16. Meachim G., Abberton M.J. Histological findings in Morton’s metatarsalgia. J Pathology 1970;103:209–17. DOI: 10.1002/path.1711030402
17. Wolfort S.F., Dellon A.L. Treatment of recurrent neuroma of the interdigital nerve by implantation of the proximal nerve into muscle in the arch of the foot. J Foot Ankle Surg 2001;40(6):404–10. DOI: 10.1016/s1067-2516(01)80009-0
18. Dang D.Y., Coughlin M.J. Mallet toes, hammertoes, neuromas, and metatarsophalangeal joint instability: 40 years of development in forefoot surgery. Indian J Orthop 2020;54(1):3–13. DOI: 10.1007/s43465-019-00015-3
19. Mak M.S., Chowdhury R., Johnson R. Morton’s neuroma: review of anatomy, pathomechanism, and imaging. Clin Radiol 2021;76(3):235.e15–35.e23. DOI: 10.1016/j.crad.2020.10.006
20. Graham C.E., Graham D.M. Morton’s neuroma: a microscopic evaluation. Foot Ankle 1984;5(3):150–3. DOI: 10.1177/107110078400500308
21. Morscher E., Ulrich J., Dick W. Morton’s intermetatarsal neuroma: morphology and histological substrate. Foot Ankle Int 2000;21(7):558–62. DOI: 10.1177/107110070002100705
22. Giakoumis M., Ryan J.D., Jani J. Histologic evaluation of intermetatarsal Morton’s neuroma. J Am Podiatr Med Assoc 2013;103(3):218–22. DOI: 10.7547/1030218
23. Pazzaglia U.E., Moalli S., Leutner M., Gera R. Morton’s neuroma: an immunohistochemical study. Foot 1996;6(2):63–5. DOI: 10.1016/S0958-2592(96)90037-1
24. Gauthier G. Thomas Morton’s disease: a nerve entrapment syndrome. A new surgical technique. Clin Orthop 1979;142:90–2. DOI: 10.1097/00003086-197907000-00014
25. Jones J.R., Klenerman L. A study of the communicating branch between the medial and lateral plantar nerves. Foot Ankle 1984;4(6):313–5. DOI: 10.1177/107110078400400608
26. Mulder J.D. The causative mechanism in Morton’s metatarsalgia. J Bone Joint Surg 1951;33-B(1):94–5. DOI: 10.1302/0301-620X.33B1.94
27. Guiloff R.J., Scadding J.W., Klenerman L. Morton’s metatarsalgia. Clinical, electrophysical and histological observations. J Bone Joint Surg Am 1984;66-B(4):586–91. DOI: 10.1302/0301-620X.66B4.6746697
28. Giannini S., Cadossi M., Luciani D., Vannini F. Morton’s neuroma. In: European surgical orthopaedics and traumatology. Ed. by: G. Bentley. Berlin: Springer, 2014. Pp. 3537–3546. DOI: 10.1007/978-3-642-34746-7_149
29. Shaihutdinov I.I., Masgutov R.F., Valeeva L.R., Yagudin R.Kh. Morton’s neuroma as a cause of pain in the foot, diagnostics and methods of treatment. Prakticheskaya medicina = Practical Medicine 2016;4–1(96):182–6. (In Russ.).
30. Sidorovich R.R., Bоyarchik V. Long-term outcomes of radiofrequency ablation in Morton’s neuroma treatment. Nevrologiya i neurokhirurgiya. Vostochnaya Evropa = Neurology and Neurosurgery. Eastern Europe 2022;12(3):259–68. (In Russ.). DOI: 10.34883/PI.2022.12.3.034
31. Saltykova V.G., Ramonova D.R., Makinyan L.G. et al. Ultrasound in foot lesion diagnosis (Morton’s neuroma, lipofibroma). Ultrazvukovaya i funktsionalnaya diagnostika = Ultrasound and Functional Diagnostics 2021;1:65–88. (In Russ.). DOI: 10.24835/1607-0771-2021-1-65-88
32. Xu Z., Duan X., Yu X. et al. The accuracy of ultrasonography and magnetic resonance imaging for the diagnosis of Morton’s neuroma: a systematic review. Clin Radiol 2015;70:351–8. DOI: 10.1016/j.crad.2014.10.017
33. Santiago F.R., Muñoz P.T., Pryest P. et al. Role of imaging methods in diagnosis and treatment of Morton’s neuroma. World J Radiol 2018;10(9):91–9. DOI: 10.4329/wjr.v10.i9.91
34. Claassen L., Bock K., Ettinger M. et al. Role of MRI in detection of Morton’s neuroma. Foot Ankle Int 2014;35(10):1002–5. DOI: 10.1177/1071100714540888
35. Sharp R.J., Wade C.M., Hennessy M.S., Saxby T.S. 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. DOI: 10.1302/0301-620x.85b7.12633
36. Slinyakov L.Yu., Bobrov D.S., Rigin N.V. et al. Basic principles of diagnosis of overload metatarsalgia in polyclinic practice. Kafedra travmatologii i ortopedii = The Department of Traumatology and Orthopedics 2015;3(15):21–4. (In Russ.).
37. Thomson L., Aujla R.S., Divall P., Bhatia M. Non-surgical treatments for Morton’s neuroma: a systematic review. Foot Ankle Surg 2020;26(7):736–43. DOI: 10.1016/j.fas.2019.09.009
38. Valisena S., Petri G.J., Ferrero A. Treatment of Morton’s neuroma: a systematic review. Foot Ankle Surg 2018;24(4):271–81. DOI: 10.1016/j.fas.2017.03.010
39. Lorenzon P., Rettore C., Scalvi A. Infiltrative therapy of Morton’s neuroma. Acta Biomed 2022;92(S3):e2021556. DOI: 10.23750/abm.v92iS3.12545
40. Klontzas M.E., Koltsakis E., Kakkos G.A., Karantanas A.H. Ultrasound-guided treatment of Morton’s neuroma. J Ultrason 2021;21(85):e134–e8. DOI: 10.15557/JoU.2021.0022
41. Barrett S.L., Rabat E., Buitrago M. et al. Endocsopic decompression of intermetatarsal nerve (EDIN) for the treatment of Morton’s entrapment – multicenter retrospective review. Open J Orthop 2012;2(2):19–24. DOI: 10.7547/0960019
42. Orlov A.Yu., Nazarov A.S., Belyakov Yu.V., Oleynik E.A. Differentiated tactics of surgical treatment of Morton’s neuroma. Rossiiskii neirokhirurgicheskii zhurnal im. prof. A.L. Polenova = Russian Neurosurgical Journal n. a. Professor A.L. Polenov 2022;14(2):108–11. (In Russ.).
43. Sidorovich R.R., Boyarchik V.P. Recurrence of pain syndrome after surgical treatment of Morton’s neuroma: opportunities of radiofrequency ablation in recurrence management. Nevrologiya i nejrohirurgiya. Vostochnaya Evropa = Neurology and Neurosurgery. Eastern Europe 2022;12(3):250–8. (In Russ.).
44. Connors J.C., Boike A.M., Rao N., Kingsley J.D. Radiofrequency ablation for the treatment of painful neuroma. J Foot Ankle Surg 2020;59(3):457–61. DOI: 10.1053/j.jfas.2019.09.003
45. Brooks D., Parr A., Bryceson W. Three cycles of radiofrequency ablation are more efficacious than two in the management of Morton’s neuroma. Foot Ankle Spec 2018;11(2):107–11. DOI: 10.1177/1938640017709905
46. Fedyakov A.G., Dreval O.N., Gorozhanin A.V. et al. Complications of Morton’s neuroma excision: classification, diagnosis, treatment and prophylaxis to help the practitioner. Rossiiskii neirokhirurgicheskii zhurnal im. prof. A.L. Polenova = Russian Neurosurgical Journal n. a. Professor A.L. Polenov 2022;14(1–1): 114–9. (In Russ.).
47. Åkermark C., Crone H., Skoog A. et al. A prospective randomized controlled trial of plantar versus dorsal incisions for operative treatment of primary Morton’s neuroma. Foot Ankle Int 2013;34(9):1198–204. DOI: 10.1177/1071100713484300
48. Kundert H.P., Plaass C., Stukenborg-Colsman C., Waizy H. Excision of Morton’s neuroma using a longitudinal plantar approach: a midterm follow-up study. Foot Ankle Spec 2016;9(1):37–42. DOI: 10.1177/1938640015599032
49. Yañez Arauz J.M. Interdigital commissural approach for Morton’s neuroma. Foot Ankle Int 2020;41(10):1226–33. DOI: 10.1177/1071100720936599
50. Mann R.A., Reynolds J.D. Interdigital neuroma – a critical clinical analysis. Foot Ankle 1983;3(4):238–43. DOI: 10.1177/107110078300300411
51. Choi J.Y., Hong W.H., Kim M.J. et al. Operative treatment options for Morton’s neuroma other than neurectomy – a systematic review. Foot Ankle Surg 2022;28(4):450–9. DOI: 10.1016/j.fas.2021.10.011
52. Park Y.H., Kim T.J., Choi G.W., Kim H.J. Prediction of clinical prognosis according to intermetatarsal distance and neuroma size on ultrasonography in Morton neuroma: a prospective observational study. J Ultrasound Med 2019;38(4):1009–14. DOI: 10.1002/jum.14787
53. Ronconi P., Arcioni R., Baleanu P.M. Radiofrequency thermoablation of Morton’s neuroma: a valid minimally invasive treatment procedure in patients resistant to conservative treatment. Open J Orthop 2013;3:325–30. DOI: 10.4236/ojo.2013.38060
54. Mo J., Rigin N.V., Bobrov D.S., Slinyakov L.Yu. Outcome rating scales for clinical evaluation of foot and ankle. Kafedra travmatologii i ortopedii = The Department of Traumatology and Orthopedics 2016;4(20):5–11. (In Russ.).
55. Habashy A., Sumarriva G., Treuting R.J. Neurectomy outcomes in patients with Morton neuroma: comparison of plantar vs dorsal approaches. Ochsner J 2016;16(4):471–4.
56. Giannini S., Bacchini P., Ceccarelli F., Vannini F. Interdigital neuroma: clinical examination and histopathologic results in 63 cases treated with excision. Foot Ankle Int 2004;25(2):79–84. DOI: 10.1177/107110070402500208
57. Bucknall V., Rutherford D., MacDonald D. et al. Outcomes following excision of Morton’s interdigital neuroma: a prospective study. Bone Joint J 2016;98-B(10):1376–81. DOI: 10.1302/0301-620X.98B10.37610
58. Petrova M.M., Schneider N.A., Pronina E.A., Bobrova O.P. Diagnosis of neuropathic pain: scales and questionnaires. Sibirskoe medicinskoe obozrenie = Siberian Medical Review 2020;3(123):61–9. (In Russ.). DOI: 10.20333/2500136-2020-3-61-69
Review
For citations:
Razin M.A., Fedyakov A.G., Kuznetsov A.V., Gorozhanin A.V., Dreval O.N. Diagnosis and treatment of Morton’s neuroma: the current state of the problem. Russian journal of neurosurgery. 2025;27(1):112-119. (In Russ.) https://doi.org/10.24412/1683-3295-2025-27-1-112-119
Views:
148
Email this article 