Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 1;12(6):1367.
doi: 10.3390/diagnostics12061367.

Study of the Anatomical Association between Morton's Neuroma and the Space Inferior to the Deep Transverse Metatarsal Ligament Using Ultrasound

María Del Mar Ruiz-Herrera  1 , Juan José Criado-Álvarez  2   3 , Mario Suarez-Ortiz  4 , Marko Konschake  5 , Simone Moroni  6 , Félix Marcos-Tejedor  2
Affiliations

Study of the Anatomical Association between Morton's Neuroma and the Space Inferior to the Deep Transverse Metatarsal Ligament Using Ultrasound

María Del Mar Ruiz-Herrera et al. Diagnostics (Basel). .

Abstract

Morton's neuroma (MN) is a common condition in clinical practice. The compressive etiology is the most accepted, in which compression occurs in the tunnel formed by the adjacent metatarsals, the deep transverse metatarsal ligament (DTML) and the plantar skin. Ultrasound (US) is a reliable method of study. The presence of insufficient space under the DTML may be related to the appearance of MN.

Objectives: To verify the relationship between MN and the space under the DTML between the metatarsal heads of the third (M3) and the fourth (M4) metatarsals using US.

Methods: This is a cross-sectional epidemiological study. The research study using the ultrasound (US) technique was carried out on 200 feet belonging to 100 patients aged 18 to 65 of both sexes, with a control group formed by 62 patients and a study group formed by 38 patients diagnosed with MN.

Results: The presence of MN and the factors associated with it were studied in 100 patients using ultrasound (US). The assessment and comparison with US of the space inferior to the DTML between M3 and M4 in control groups and patients with MN show that patients with MN have a smaller size in the variable "h" (height or distance DTML-plantar skin), in the variable "b" (base or intermetatarsal distance M3 and M4) and in the variable "s" (surface of the parallelogram "h" × "b"). The predictors of MN are a decrease in dimension "b" and an increase in weight. Sitting in an office chair and the use of a bicycle, due to equinus, have an influence on the space below the DTML, reducing it and promoting the appearance of MN.

Conclusions: The two US measurements ("h" and "b") in the space below the DTML are smaller in patients with MN than in the asymptomatic group. A shorter distance between M3 and M4, and an increase in BMI are predictors of MN.

Keywords: Morton’s neuroma; deep transverse metatarsal ligament; podiatry; ultrasonography.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Representation of the anatomical space between the third and fourth metatarsal heads. C3 and C4: metatarsal heads 3 and 4; h: distance between the DTML and the plantar skin in the middle area between the M3 and M4 metatarsal heads; b: closest intermetatarsal distance between C3 and C4; MN in yellow circle: Morton’s neuroma.
Figure 2
Figure 2
Painful echopalpation of MN: the tip of the pen presses on Morton’s neuroma, causing pain. The ultrasound image shows “the comet’s tail” produced by the tip of the pen. The blue arrow indicates the hyperechoic image produced by the pen, and the red arrow indicates the position of the MN. The yellow circle shows the MN.
Figure 3
Figure 3
Ultrasound imaging of the measurements.C3 and C4: metatarsal heads 3 and 4 (M3 and M4); DTML: deep transverse metatarsal ligament; h: height: distance between the DTML and the plantar skin in the middle area between M3 and M4; b: base: distance between M3 and M4; MN: Morton’s neuroma.
See this image and copyright information in PMC

References

    1. Quinn T.J., Jacobson J.A., Craig J.G., van Holsbeeck M.T. Sonography of Morton’s neuromas. Am. J. Roentgenol. 2000;174:1723–1728. doi: 10.2214/ajr.174.6.1741723. - DOI - PubMed
    1. Gougoulias N., Lampridis V., Sakellariou A. Morton’s interdigital neuroma: Instructional review. EFORT Open Rev. 2019;4:14–24. doi: 10.1302/2058-5241.4.180025. - DOI - PMC - PubMed
    1. Park Y.H., Kim T.J., Choi G.W., Kim H.J. Prediction of Clinical Prognosis according to Intermetatarsal Distance and Neuroma Size on Ultrasonography in Morton Neuroma: A Prospective Observational Study. J. Ultrasound Med. 2019;38:1009–1014. doi: 10.1002/jum.14787. - DOI - PubMed
    1. Kim J.-Y., Choi J.H., Park J., Wang J., Lee I. An anatomical study of Morton’s interdigital neuroma: The relationship between the occurring site and the Deep Transverse Metatarsal Ligament (DTML) Foot Ankle Int. 2007;28:1007–1010. doi: 10.3113/FAI.2007.1007. - DOI - PubMed
    1. Hulstaert T., Shahabpour M., Provyn S., Lenchik L., Simons P., Vanheste R., De Maeseneer M. Forefoot Pain in the Lesser Toes: Anatomical Considerations and Magnetic Resonance Imaging Findings. Can. Assoc. Radiol. J. 2019;70:408–415. doi: 10.1016/j.carj.2019.06.010. - DOI - PubMed