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The patient present with forefoot pain which radiates from midfoot to toes.
Well defined, hypoechoic, round lesion with a lobulated outline, between the third and fourth metatarsals, just proximal to metatarsal heads.
Morton neuromas, also known as intermetatarsal neuromas, are focal areas of symptomatic perineural fibrosis around the plantar digital nerve of the foot. The condition is thought to be due to chronic entrapment of the never by the intermetatarsal ligament.
It most commonly affects the third web space (between the 3rd and 4th metatarsal heads).
The symptomatic lesion tends to be slightly larger, lesions >5mm are very likely to be symptomatic.
Ultrasound typically shows a round to ovoid, well-defined, hypoechoic lesion in the intermetatarsal space proximal to the metatarsal head.
A sonographic Mulder sign may be elicited with the ultrasound probe.
The treatment includes ultrasound-guided interdigital injection of steroid and local anesthesia with a relatively high success rate.
- 1. Sofka C, Adler R, Ciavarra G, Pavlov H. Ultrasound-Guided Interdigital Neuroma Injections: Short-Term Clinical Outcomes After a Single Percutaneous Injection—Preliminary Results. HSS Jrnl. 2006;3(1):44-9. doi:10.1007/s11420-006-9029-9 - Pubmed
- 2. Torriani M & Kattapuram S. Dynamic Sonography of the Forefoot: The Sonographic Mulder Sign. AJR Am J Roentgenol. 2003;180(4):1121-3. doi:10.2214/ajr.180.4.1801121 - Pubmed