Our case report is entitled Toe Spacer Relieves Morton's Neuroma Symptoms and Increases Distance from Metatarsal Heads. Morton's neuroma is one of the most common causes of metatarsalgia. It is not a true neuroma, but instead a proliferative fibrosis of interdigital perineural tissue. Typical presentation is in middle age and it affects women more than men. Most etiologies include chronic repetitive trauma, ischemia, entrapments, and intermetatarsal bursitis. The diagnosis is clinical and non-operative treatments focus on footwear modifications, custom-made orthoses, and local injections. Operative management involves either decompression of the nerve or neurectomy, and systematic reviews of the literature show better outcomes with operative management. Our case involves a 57-year-old female with a past medical history significant for ovarian cancer. She was diagnosed three years ago and completed taxol and carboplatin chemotherapy. She presented to an academic musculoskeletal clinic with an eight-month history of foot pain. The foot pain is located anterior to the second and third metatarsal heads and occurred with weight bearing. There was no inciting event and she noted no improvements with arch support or changes in footwear. Physical examination was notable for tenderness to palpation anterior to the left, second, and third metatarsal heads. A positive metatarsal squeeze test and loss of vibration sense to the tibial plateau by laterally. We show in figure one, the silicone toe spacer increases the distance between the lower edge of the Morton's neuroma and the metatarsal heads visualized by dynamic ultrasound. In each panel, the dotted line with terminal plus signs represents the plane of the metatarsal heads, and the dotted line with terminal Xs represents the distance from the bottom edge of the neuroma to the plane of the metatarsal heads. With no pressure applied by the ultrasound probe and no toe spacer, the bottom edge of the Morton's neuroma lay 0.1 centimeters above the plane of the metatarsal heads as seen in panel A. In panel B, symptomatic pressure was applied using the ultrasound probe and the Morton's neuroma dropped to 0.08 centimeters below the plane of the metatarsal heads. In panel D, with the same amount of pressure applied as in panel B, but with a silicone toe spacer inserted between the second and third toes, the bottom edge of the Morton's neuroma raised to 0.2 centimeters above the plane of the metatarsal heads. And with release of that pressure from the ultrasound probe, the bottom edge of the Morton's neuroma raised a little bit more to 0.23 centimeters above the plane of the metatarsal heads as seen in panel C. Dynamic ultrasound showed that when pressure is applied to the forefoot, the Morton's neuroma dropped between the metatarsal heads, increasing pressure on the interdigital nerve. However, with a toe spacer inserted between the affected toes, this increased the distance between the Morton's neuroma and the plane of the metatarsal heads, which would reduce impingement of the nerve and relieve symptoms. The conclusion of our case study was that by increasing the distance between the Morton's neuroma and the plane of the metatarsal heads, inexpensive silicone toe spacers can relieve pressure-related neuropathic symptoms. Thank you for your attention, and if you have any questions or feedback on our poster, please feel free to contact me at the information on the bottom left of the poster. Thank you.

toe spacer

Morton's neuroma

foot pain

fibrosis

repetitive trauma