What are the signs and symptoms of interdigital neuritis?

Updated: Oct 15, 2019
  • Author: Minoo Hadjari Hollis, MD; Chief Editor: Thomas M DeBerardino, MD  more...
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Answer

Many patients with interdigital neuritis (also known as Morton neuroma, Morton metatarsalgia, interdigital neuroma, or interdigital nerve compression) present with an intermittent dull ache or cramping sensation on the plantar aspect of either the second or the third interspace. Many patients present with a vague discomfort in the involved toes, and some may feel numbness or burning, with occasional shooting pain. Some patients notice spreading of the involved toes, and others may notice symptoms only with certain shoes.

Symptoms are usually exacerbated by walking, particularly with bare feet on hard surfaces, and sudden sharp pain may result from various activities (eg, sprinting, jumping, squatting, or repeated hopping) or from the wearing of high-heeled or tight shoes. Symptoms improve with rest, and night pain is rare. With progression of the condition, pain may radiate proximally. In chronic cases, patients may sense a mass or a stone bruise in the ball of the foot.

Nearly equal involvement of the second and third interspaces has been reported in the literature; involvement of the first and fourth spaces also has been reported, albeit rarely. Simultaneous tenderness in the second and third interspaces is not rare. Bilateral cases have been reported but are uncommon. Other pathologies of the forefoot (eg, instability of the second metatarsophalangeal [MTP] joint) are frequently present. Coughlin et al reported that 20% of their patients originally had concomitant instability of an adjacent MTP joint.

Clinically, dorsoplantar compression of the second or third intermetatarsal space reproduces pain that may radiate to the toes or proximally along the course of the affected nerve. The patient may display relative paresthesia of the webspace supplied by the injured nerve, though this relative paresthesia is often difficult to ascertain.


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