Misdiagnosed Morton’s versus Hauser’s neuroma

Abstract

Introduction: Morton's and Hauser's neuromas are interdigital neuromas that occur at the third and second intermetatarsal space, respectively. Patients typically present with numbness or pain in the affected toes that is exacerbated with activity. Overpronation, activities that increase forefoot pressure, tight shoes, and female sex are associated, although males can also be affected. Etiology is believed to involve collapse of the transverse arch, increased traction and inflammation of the digital plantar nerves, entrapment by the transverse interdigital ligament, and scar tissue formation. Their identical etiology is one of the reasons behind the similar presentations of interdigital neuromas and their source of diagnostic confusion. Case Description: The patient is a 23-year-old male with no significant past medical history complaining of shooting pain in his right foot for three weeks that began abruptly. He denied wearing narrow toed shoes. Physical exam elicited tenderness at the right second and third digits. X-ray of the foot was negative. He was unsuccessfully treated for a plantar injury, then a pinched nerve. MRI indicated neuromas at the second and third intermetatarsal webspace, and he was diagnosed with Morton's neuroma. He continued to fail conservative treatment and eventually underwent surgery to remove the neuromas. A 8x6mm and 3x2mm webspace neuroma was removed from the second and third intermetatarsal webspaces, respectively, and his symptoms resolved. Discussion: This case presents a misdiagnosed neuroma that was likely treated with an incorrect conservative treatment regime, prolonging patient discomfort and increasing treatment time and medical fees. It is also exposes the misconception that plantar neuromas are all grouped together under the diagnosis of Morton's neuroma. Education is necessary to differentiate between interdigital neuromas, ensuring more accurate diagnosis and better management of this common dysfunction. Further research should be conducted to determine the best treatment algorithm, taking into consideration the patient's symptomatology and neuroma size.