Isolated reports showed that up to a third of patients are asymptomatic [4], but in many individuals, pain originating from the nerves of the affected foot is present. The pain may be extreme enough to prevent patients from walking [1].

The diagnosis should be rather easily made, as a compression test of the foot can reveal the painful site and determine the affected web space [2]. To confirm Morton's metatarsalgia, however, either ultrasonography or MRI can be performed and both procedures show very good results [5].

Modification of footwear, injection of corticosteroids or local anesthetics and use of custom-made orthoses are conservative measures currently used to relieve symptoms of metatarsalgia [3] [6], but in severe cases, surgical neurectomy (with a maximal success rate of 83%) may be necessary to alleviate pain [3]. A significant difference between non-surgical and surgical approaches was not observed, however [1], and an individualized approach should be favored.

Patients present with a varying severity of symptoms, but pain may be so severe that is can markedly impair the quality of life, which is why early recognition of the disorder and appropriate treatment is necessary.

The exact cause of Morton's metatarsalgia remains unknown, but various conditions have been described, including ischemia, bursitis, and chronic trauma [3]. The term Morton's neuroma is often used to erroneously suggest a neoplastic origin of the condition, but histological examinations have revealed the presence of inflammatory tissue and perineural fibrosis [6], implicating that other events are responsible for its development.

A significant predilection toward middle-aged women was observed, presumably due to using inadequate footwear that induces substantial anatomical malformations of the foot [2] [6]. The exact prevalence rates in the population are unknown.

Mechanically-induced neuropathy, occurring on the grounds of substantial disruption of the normal foot physiology by improper footwear, is the most probable pathogenesis model [2].

Wearing appropriate footwear that provides comfort and maintains a regular anatomical position of the foot may be recommended as a preventive strategy.

Morton's metatarsalgia (also known as Morton's neuroma) is considered to be a mechanically-induced neuropathy of the foot, most likely involving the third digital nerve of the toes [1] [2]. The exact cause, however, is yet to be determined, as chronic trauma, ischemia and bursitis have been described in the pathogenesis as well [3]. The condition is most prevalent in middle-aged women wearing high heels, supporting the fact that mechanically-induced damage through wear of fashion shoes that are not in accordance with the physiological position of the foot results in this condition [2]. The clinical presentation ranges from the presence of few symptoms to a severely debilitating pain that impairs normal walking [4] [5]. A physical examination supported by ultrasonography or magnetic resonance imaging (MRI) is sufficient to make the diagnosis [3] [5]. Footwear modifications, use of orthoses, steroids or local anesthetics are conservative measures described in therapy [6], whereas neurectomy may be performed if all other modalities fail [3].

Morton's metatarsalgia is a condition that denotes the appearance of pain in the middle aspect of the foot, most commonly as a result of inadequate footwear and subsequent nerve compression and injury. The fact that the condition is most prevalent in middle-aged women who wear shoes with high heels that disrupt the normal anatomy of the foot, further supporting this theory. The exact cause and mechanism of disease, however, is yet to be determined, as other conditions such as bursitis, ischemia and trauma have been associated with Morton's metatarsalgia. Foot pain is the principal symptom and some patients may report excruciating pain that reduces their ability to walk normally. The diagnosis should be made during a regular physical examination, but either ultrasonography or magnetic resonance imaging can be used for confirmation. Treatment initially consists of conservative measures - footwear modification, use of local anesthetics and orthoses, while surgical procedures to remove damaged nerve tissue are performed as a last resort.

1. Thomson CE, Gibson JN, Martin D. Interventions for the treatment of Morton's neuroma. Cochrane Database Syst Rev. 2004;(3):CD003118.
2. Wu KK. Morton neuroma and metatarsalgia. Curr Opin Rheumatol. 2000;12(2):131-142.
3. Hassouna H, Singh D. Morton's metatarsalgia: pathogenesis, aetiology and current management. Acta Orthop Belg. 2005;71(6):646-655.
4. Bencardino J, Rosenberg ZS, Beltran J, Liu X, Marty-Delfaut E. Morton's neuroma: is it always symptomatic? AJR Am J Roentgenol. 2000;175(3):649-653.
5. Bignotti B, Signori A, Sormani MP, Molfetta L, Martinoli C, Tagliafico A. Ultrasound versus magnetic resonance imaging for Morton neuroma: systematic review and meta-analysis. Eur Radiol. 2015;25(8):2254-2262.
6. Jain S, Mannan K. The diagnosis and management of Morton's neuroma: a literature review. Foot Ankle Spec. 2013;6(4):307-317.