Morton’s neuroma is a common cause of forefoot pain. Although it is given the name neuroma, it is well recognised that this is not a nerve tumour but rather represents a combination of inflammatory changes around the interdigital nerve with inter metatarsal bursitis. Some author’s seem to differentiate between these two conditions however it is likely that in most cases a combination of both is present. The clinical pictures is typical. The patients complain of forefoot pain particularly on walking which may be accompanied by a tingling or numb sensation in the involved toes. The commonest interspaces described are the 2nd/3rd and 3rd/4th.
Morton's neuromas also have to be differentiated from plantar plate injuries. Plantar plate tears are most common in the 2nd MTPJ, affecting the lateral aspect of the plate. Pericapsular fibrosis commonly accompanies the tear and the appearances can mimic the perineural fibrosis of Morton's neuroma. There is a body of opinion that 2/3 interspace Morton's are much less common that previously thought and many of the lesions encountered in this interspace represent pericapsular fibrosis related to plantar plate injuries.
