Question
A 50 year old woman has burning pain between her third and fourth toes when wearing narrow shoes. This is the histology after excision.
- Describe the histology and the diagnosis.
- How is it diagnosed clinically?
- Outline management and the outcomes of surgery.
Answer
Histology
- Thickened digital nerve with perineural fibrosis
- Endoneurial oedema and degeneration of nerve fibres
- Interdigital (Morton) neuroma, a compressive neuropathy, not a true neoplasm
Clinical diagnosis
- Third web space most common
- Plantar pain radiating to the toes, relieved by removing shoes
- Mulder click with web space compression
- Toe splaying
- Ultrasound or MRI if uncertain
- Exclude MTP synovitis, plantar plate tear and stress fracture
Management
- Wide toe box shoes and metatarsal pad
- Corticosteroid or alcohol injection
- Excision through a dorsal incision, divide the deep transverse metatarsal ligament
- Resect the nerve proximal to the ligament
- Outcomes good in about 80%
- Recurrent or stump neuroma, revise through a plantar incision with proximal resection
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.