Morton's neuroma: a review of recent concepts

A number of new concepts in the pathology, diagnosis, and management of Morton's metatarsalgia have been presented in the recent literature. Probably as many questions as answers have been generated by these publications. The taut transverse metatarsal ligament appears to play a critical role compressing the interdigital nerve but the exact pathomechanics producing the neuroma and the role of the intermetatarsal bursa remain unclear. Electrodiagnostic techniques for this condition are in the early development stage and may be clinically applicable in the near future. Support for and recommendation against the preoperative injection of the intermetatarsal bursa and interdigital nerve area have been discussed. The necessity of interdigital neurectomy has been questioned but currently in North America, simple transverse metatarsal ligament division has not been widely utilized. Continued studies along these lines should improve our understanding of Morton's metatarsalgia, increase our diagnostic accuracy, and facilitate more effective management.