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Medicina e Chirurgia della Caviglia e del Piede 2014 December;38(3):105-13


language: Italian

Morton’s neuroma, pathogenetic labyrinth: a new biomechanical theory

Vittore D. 1, Dilonardo M. 1, Abate A. 1, Cassano A. 1, Volpe A. 2, Caizzi G. 3

1 Dipartimento Medicina Clinica e Sperimentale, Università Degli Studi di Foggia, Struttura Complessa di Ortopedia e Traumatologia Universitaria, Ospedali Riuniti Foggia, Foggia, Italia; 2 Direttore Foot and Ankle Clinic, Policlinico Abano Terme, Padova, Italia; 3 Dipartimento di Scienze Mediche di Base, Neuroscienze e Organi di Senso, Università degli Studi di Bari “Aldo Moro”, Policlinico di Bari, Unità Operativa di Ortopedia e Traumatologia, Bari, Italia


Civinini-Morton metatarsalgia is a painful syndrome of the foot not associated with neoplastic lesions contrary to the term “neuroma”, that usually describes this condition. Perineural fibrosis surrounding intermetatarsal nerve is the main pathological lesion. This condition is classically explained in literature through four hypotheses. The first is the “chronic trauma”: stresses associated with normal standing and walking cause, in biomechanically predisposed foot, “irritation” of the intermetatarsal nerves, with development of chronic inflammation and fibrosis. “Ischemic” theory describes vasa nervorum inflammation, secondary to a progression of endarteritis-thrombosis-partial recanalization, as the main cause associated with neural ischemia and post-necrotic fibrosis. A third theory describes the presence of intermetatarsal bursitis secondary to biomechanical overload. The last theory considers the nerve entrapped between the intermetatarsal ligament and the plantar fascia during the detachment of the foot from the ground, during normal walking sequence. Authors agree about the simultaneous contribute of each of this theory to the final clinical findings. We propose a new pathogenetic hypothesis, deriving from our clinical and radiological study on patients complaining about this condition. Intermetatarsal conflict should be supported by the transverse head of the adductor hallucis (THAH). It originates from the third, fourth and fifth metatarsophalangeal joint and then it joins the flexor hallucis longus tendon, behaving as an active metatarsal stabilizer. An excessive activation of the THAH may cause narrowing of the space between III-IV metatarsal. Third metatarsal is physiologically characterized by limited motility; when a pathological activation of THAH prevails, it would stretch the fourth metatarsal bone, causing compression of the intermetatarsal nerve. The introduction and identification of this condition contributes to an etiological treatment approach, which we strongly believe to be useful and effective in the final resolution of this morbid condition.

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