If the neuroma is large enough, the adjacent toes may be forced to spread apart on weight bearing. Because Morton's neuroma causes a distinct set of clinical symptoms, diagnosis most often can be made from the patient history. The pain from this syndrome is often described as sharp, dull, throbbing, or of electricity shooting into the toes. The patient may describe numbness in the adjacent toes, though there is rarely a sensory deficit 29 . The pain is aggravated by walking and is relieved by rest.
Most patients state that removing the shoes and rubbing the feet provide the best relief.
Examination Tenderness and reproduction of the described pain can often be elicited by squeezing each interspace in a dorso-plantar direction at or distal to the metatarsophalangeal space. A palpable mass may be present. Lateral compression while squeezing the interspace may elicit a palpable click known as a positive Mulder's sign 30 . Local tenderness needs to be differentiated from arthritic pain by palpating the adjacent metatarsophalangeal joints. Management Non-operative treatment is frequently beneficial to the patient and should be geared toward avoiding irritation to the neuroma.