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Musculoskeletal46 papers

Morton's metatarsalgia

Last edited: 4/15/2026

Overview

Morton's metatarsalgia, also known as Morton's neuroma, involves entrapment and irritation of the common digital plantar nerve, typically between the third and fourth metatarsal heads, leading to pain, particularly with weight-bearing activities 1.

Diagnosis

  • Clinical Presentation: Pain and discomfort in the forefoot, often described as a burning sensation or feeling of walking on a pebble 1.
  • Physical Examination: Mulder sign (clicking sensation between metatarsal heads on palpation) and palpation tenderness over the interdigital space 1.
  • Imaging: Ultrasound or MRI can confirm diagnosis by visualizing nerve thickening or other structural changes 1.

    • Management

  • First-Line Treatments:
    • - Custom Orthotics: Metatarsal pads or custom insoles to redistribute pressure 1. - Wide Toe Box Shoes: To minimize compression of the forefoot 1.
  • Adjunctive Treatments:
    • - Corticosteroid Injections: Local injections to reduce inflammation 1. - Physical Therapy: Stretching and strengthening exercises for foot muscles 1.

    Special Populations

  • Pregnancy: Management focuses on conservative measures such as supportive footwear and orthotics due to limited treatment options 1.
  • Elderly: Custom orthotics and careful shoe selection are crucial to prevent exacerbation of symptoms 1.

    • Key Recommendations

  • Utilize custom orthotics with metatarsal padding for symptom relief (Evidence: Expert opinion) 1.
  • Recommend wide toe box footwear to alleviate pressure on the forefoot (Evidence: Expert opinion) 1.
  • Consider corticosteroid injections for refractory cases, though evidence is limited (Evidence: Weak) 1.

    • References

    1 Freeman B. Hans von Baeyer (1875-1941) and his 1909 Insole with Metatarsal Padding for Treating Metatarsalgia. Journal of the American Podiatric Medical Association 2020. link

    Original source

    1. [1]
      Hans von Baeyer (1875-1941) and his 1909 Insole with Metatarsal Padding for Treating Metatarsalgia. — Freeman B Journal of the American Podiatric Medical Association (2020)
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