Morton's metatarsalgia: pathogenesis, aetiology and current management.

The aetiology and pathogenesis of Morton's Neuroma remain controversial. It is not true neuroma and therefore, it is better referred to as Morton's metatarsalgia. This article reviews the various thoughts regarding the pathogenesis of this condition. Chronic trauma, ischaemia, bursitis and entrapment neuropathy have been proposed as possible aetiologic factors. Careful history and clinical examination is essential to establish the diagnosis. However, if the clinical picture is doubtful, radiological investigation is recommended. Ultrasound, in the hand of an experienced radiologist, is the modality of choice. Conservative measures such as footwear modification and targeted injection of the hot spot are attempted before considering surgical intervention. Patients must be counselled preoperatively. The success of neurectomy rarely exceeds 83%. When surgery is considered, the dorsal approach is associated with less wound complications than the plantar approach. The neuroma is resected as proximally as possible in order to include plantar digital branches. For recurrent neuromas, a plantar approach is appropriate.