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CONDITION/DISORDER SYNONYMS

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  • Intermetatarsal disorder

  • Morton metatarsalgia

  • Plantar nerve lesion

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ICD-9-CM-CODE

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  • 355.6 Lesion of plantar nerve

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ICD-10-CM CODES

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  • G57.6 Lesion of plantar nerve

  • G57.60 Lesion of plantar nerve, unspecified lower limb

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PREFERRED PRACTICE PATTERN

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  • 5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated with Peripheral Nerve Injury

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PATIENT PRESENTATION

A 42-year-old female presents with a severe pain in the ball of her right foot that radiates into her second and third toes. She states the pain started about 1 week ago. She describes the pain as being sharp and burning in nature. She does not recall a specific injury but does state that she started barefoot running 6 weeks ago and eliminated her heel strike. She also goes to dance classes for the past 4 weeks. She feels better with a hard soled shoe on but cannot wear her dress shoes, especially heels. Upon palpation there is a thickening of the tissue between toes 2 and 3 right. Tenderness is present in the same region. There is hypomobility of the MTP toes 2 and 3 right and a positive pinch test. The patient’s radiograph, which was ordered by the referring physician, is negative for any fractures.

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KEY FEATURES

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Description
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  • Painful condition that affects the ball of the foot

  • Growth of scar tissue from chronic irritation of compression

  • Most common area is between the third and fourth toes, but also can be in between the second and third toes

  • Involves a thickening of the tissues (neuroma) around one of the intermetatarsal plantar nerves

  • Branches from the medial and lateral plantar nerves

  • May alter mechanics during the push-off phase of gait

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Essentials of Diagnosis
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  • Can be an independent diagnosis and not associated with a disease process

  • Characterized by numbness, burning, and pain

  • Sometimes relieved by removing shoes

  • No visible deformity

  • Higher risk for individuals with bunions and flat feet

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FIGURE 225-1

Morton neuroma. (From Simon RR, Sherman SC. Emergency Orthopedics. 6th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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General Considerations
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  • Feeling like you are stepping on something like a pebble

  • A burning pain in the ball of the foot that radiates to the toes

  • Tingling or numbness in the toes

  • Titled a neuroma, but is not a tumor formation as “oma”

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Demographics
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  • Ladies wearing high heels

  • Rock climbers with repetitive forefoot pressure

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CLINICAL FINDINGS

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SIGNS AND SYMPTOMS

  • Burning pain in the ball of the foot

  • Numbness and tingling in the toes, especially between the third and fourth toes

  • Difficulty wearing/finding shoes, ...

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