Morton’s neuroma: A systematic review of pathophysiology, diagnosis, and management
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1
Dr. Anna Gostyńska Wolski Hospital, Warsaw, Poland
2
Praski Hospital of the Transfiguration of Our Lord, Warsaw, Poland
3
Warsaw Southern Hospital, Warsaw, Poland
4
Central Clinical Hospital of UCC WUM
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ABSTRACT
Morton’s neuroma (MN) is a common neuropathy of the interdigital nerve, most often between the third and fourth metatarsal heads. Despite its common occurrence, approaches to diagnosis and treatment may differ. This review summarizes current evidence on the pathophysiology, diagnostic evaluation, and management of MN. We conducted a PubMed search up to October 2025, using the terms “Morton’s neuroma,” “interdigital neuralgia,” “forefoot pain,” and “nerve entrapment,” with a focus on clinical presentation, imaging, and treatment. Included studies were randomized controlled trials, cohort studies, and systematic reviews, while case reports, letters, non-English articles, and conference abstracts were excluded. Morton’s neuroma typically affects middle-aged women, and it's commonly related to mechanical compression, footwear, and foot biomechanics. Diagnosis is mainly clinical, with provocative tests, such as Mulder's click, helping to identify the condition. Ultrasound is a first-line imaging tool, due to its high diagnostic accuracy and capacity for real-time guidance. Non-surgical therapies, such as footwear change, orthoses, and ultrasound-guided corticosteroid injections, can provide short-term symptom improvement, usually lasting up to 12 months. Approximately one-third of patients may require surgery. Surgical options, such as neurectomy, intermetatarsal ligament release, and dorsal nerve transposition, can provide long-term relief, but they carry risks of sensory loss, stump neuroma, and recurrence. Emerging minimally invasive techniques show potential but need further study. Management should be tailored to the severity of symptoms and their functional impact to achieve the best outcomes.
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