Morton's toe neuroma

Clnical-- burning pain over the head of the fourth metatarsal radiating into the toe. Pain is worse by standing and/or walking, better with lying or elevating the foot. Extending the toes by squatting or kneeling makes it worse. Exam may show diminished sensation on the medial half of the fourth toe. Nerve conductions may involve simultaneous recording of toes I and V with reference electrode i between. The cause is traumatic. It may be related to walking, jogging, squatting or wearing high heeled shoes. Treatment is padding the metatarsal head in shoe, or eventually surgery to remove the nerve is definitive. It is usually a white fibrous enlargement at the branch point of the nerve. Alternative procedure is release the ligament of the deep plantar fascia without excision of the neuroma.