Interdigital Neuroma


REDUCE YOUR NEUROMA PAIN TODAY


What is an Interdigtal Neuroma ?

Interdigital Neuroma (also known as Morton’s neuroma) is a thickening of the nerve sheath that supplies sensation to the area between the toes. It often presents as pain on the ball of the foot. Neurological symptoms are also common with a neuroma and including burning, tingling, numbness and pain in the region of the  forefoot.

An interdigital neuroma occurs most commonly in the third web space (Morton’s Neuroma) (72% of cases) followed by the second (30% of cases) and the fourth (5% of cases).  (2)


Causes of an Interdigital Neuroma ?

The exact cause of an interdigitial neuroma  is unclear. It is thought that a neuroma is the result of a combination of a compression trauma and  ischemic (lack of blood flow) entrapment neuropathy of the common plantar digital  nerve (see the diagram below of a cross section of the forefoot).
It has been suggested that the common plantar digital nerve is repeatedly compressed between the bottom of the foot and the edge of the transverse inter-metatarsal ligament.  The result is a chronic irritation of the nerve results in the subsequent development of a benign fibrotic degeneration within the nerve.

The picture below shoes the changes within a Interdigital neuroma (3). Of note is the increased disorganisation of the fibrous bands surrounding the nerves.

The irritation of the nerve is thought to be made worse with:


Diagnosis of an Interdigital Neuroma

Diagnosis is usually based or symptoms and a complete assessment of your foot and ankle.

At the Foot an Ankle Centre we are able to provide additional information about the presence of a neuroma with ultrasound imaging.

Typically a neuroma will present as a non compressible mass between the web space as shown in the picture above and the video below.


Treatment of an Interdigital Neuroma

Treatment aims to reduce the disorganised mass within the nerve and also offload the forefoot to prevent its re-occurrence.

1. Reduction of the disorganised mass can include

(percentage success rate from a recent systematic review published in 2017 by Valisena click here for the article)

2. Offloading the interdigital mass can  be achieved with

  • Shoe stretching and modification (rocker sole modification)
  • Metatarsal domes
  • Custom made Orthotics with a metatarsal dome incorporated into the design
    Neuroma Orthotic

What else could it be? (differential diagnosis)

Other problems that can cause similar pain to a neuroma include:


The Ankle, Foot and Orthotic Centre’s Northcote Podiatrists can help you with all lower limb complaints, including Neuroma. Make an appointment to get your foot and ankle pain under control.

Expert Podiatrists for the treatment of Neuromas servicing the areas of Northcote, Thornbury, Fitzroy, North Fitzroy, Carlton, North Carlton, Alphington, Fairfield, Brunswick, Coburg and Preston

Call The Ankle, Foot and Orthotic Centre for diagnosis and advice on professional management and treatment options.


 

References

1.Bossley CJ, Cairney PC. The intermetatarsophalangeal bursa–its significance in Morton’s metatarsalgia. J Bone Joint Surg Br. 1980;62-B(2):184-7.

2.Giakoumis M, Ryan JD, Jani J. Histologic Evaluation of Intermetatarsal Morton’s Neuroma. Journal of the American Podiatric Medical Association. 2013;103(3):218-22.

3.Stecco C, Fantoni I, Macchi V, Del Borrello M, Porzionato A, Biz C, et al. The role of fasciae in Civinini-Morton’s syndrome. J Anat. 2015;227(5):654-64.

4.Bianchi S. Practical US of the forefoot. J Ultrasound. 2014;17(2):151-64.

5.Cohen SL, Miller TT, Ellis SJ, Roberts MM, DiCarlo EF. Sonography of Morton Neuromas: What Are We Really Looking At? J Ultrasound Med. 2016;35(10):2191-5.

6.Wu KK. Morton neuroma and metatarsalgia. Curr Opin Rheumatol. 2000;12(2):131-42

7.Decherchi P. [Thomas George Morton metatarsalgia]. Presse Med. 2007;36(7-8):1098-103.

8.Rajput K, Reddy S, Shankar H. Painful neuromas. Clin J Pain. 2012;28(7):639-45.

9.Perini L, Borrello MD, Cipriano R, Cavallo A, Volpe A. Dynamic sonography of the forefoot in Morton’s syndrome: correlation with magnetic resonance and surgery. Radiol med. 2006;111(7):897-905.

10.Bignotti B, Signori A, Sormani MP, Molfetta L, Martinoli C, Tagliafico A. Ultrasound versus magnetic resonance imaging for Morton neuroma: systematic review and meta-analysis. Eur Radiol. 2015;25(8):2254-62.

11.Zanetti M, Weishaupt D. MR Imaging of the Forefoot: Morton Neuroma and Differential Diagnoses. Seminars In Musculoskeletal Radiology. 2005;09(03):175-86.

12.Chauveaux D, Huec JCL, Midy D. The supra-transverse intermetatarsocapital bursa: a description and its relation to painful syndromes of the forefoot. Surg Radiol Anat. 1987;9(1):13-8.

13.Lee M-J, Kim S, Huh Y-M, Song H-T, Lee S-A, Lee JW, et al. Morton Neuroma: Evaluated with Ultrasonography and MR Imaging. Korean J Radiol. 2007;8(2):148-55.

14.Kankanala G, Jain AS. The Operational Characteristics of Ultrasonography for the Diagnosis of Plantar Intermetatarsal Neuroma. The Journal of Foot and Ankle Surgery.46:213-7.

15. Fazal MA, Khan I, Thomas C. Ultrasonography and magnetic resonance imaging in the diagnosis of Morton’s neuroma. Journal of the American Podiatric Medical Association. 2012;102(3):184-6

16.Valisena S, Petri GJ, Ferrero A. Treatment of Morton’s neuroma: A systematic review. Foot and Ankle Surgery. 2017.