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Morton’s neuroma is a common primary diagnosis for referral to foot and
ankle surgeons. On presentation, many patients have had an ultrasound
reporting the presence of Morton’s neuroma, which may not correlate
with the clinical examination findings. The prevalence of such
sonographic findings in the general population remains unknown.
Methods: In this observational prospective study, patients with
asymptomatic forefeet who were seen by two foot and ankle surgeons for
unrelated mid- or hind foot pathology were examined clinically and
sonographically for the presence of interdigital nerve thickening.
Forty-eight volunteers participated in the study (96 feet). For the
purpose of this study, asymptomatic thickenings greater than 5 mm in
diameter were termed sonographic neuromas. Ultrasound examination was
performed by two specialist musculoskeletal radiologists.
Fifty-four percent of the volunteers (26 of 48) had sonographic nerve
thickening and in 17 cases (35.4%) enlarged nerves were found
bilaterally. Differences for gender, original diagnosis or side of
original pathology were not significant. Older subjects were more
likely to have a sonographic neuroma (p = 0.018). Feet with a positive
Mulder’s click were more likely to have a sonographic neuroma (p =
Conclusion: Ultrasound, even in highly skilled hands, has a
high rate of incidental finding of an asymptomatic interdigital nerve
enlargement, which can lead to a false diagnosis of a Morton’s neuroma.
Sonographic evidence of Morton’s neuroma per se is unreliable unless it
is correlated with an equivocal clinical examination. Clinical
examination is still the gold standard for the diagnosis of a Morton’s
Re: Prevalence of Asymptomatic Interdigital Nerve Enlargements
Hmmmm slightly puzzling. First define a 'Morton's neuroma', second confirm what is a Mulder's sign and even if it exists, does it have any significance, and finally, as far as I am concerned, there is very little enlargement of the digital nerves in a symptomatic condition. The nerve hypertrophy in all the patients that I have seen, is intermetatarsal head.