The examiner grasps the patient’s forefoot in a pincer grip and compresses it.
This pushes the adjacent metatarsal heads against each other.
What does a positive Mortons Neuroma Test mean?
Where an interdigital neuroma is present, pushing the metatarsal heads against one another will cause pain with occasional paresthesia radiating into the adjacent toes.
Small fibroma like hardened areas between the toes will also be palpable and will displace, sometimes with a clicking sound, as the forefoot is compressed.
Sensitivity & Accuracy
A Comparative Study1 by Devendra Mahadevan to assess the diagnostic accuracy of 7 clinical tests for Morton’s neuroma (MN) compared with ultrasonography (US) on Forty patients (54 feet), he found that the Sensitivity & Accuracy of Mortons Neuroma Test was:
Morton’s neuroma is a spindle-shaped bulb that develops in a plantar nerve. Painful interdigital neuromas usually develop in the second or third interdigital fold; neuromas in the first or fourth interdigital fold are rare.
It manifests with metatarsalgia and sometimes numbness and tingling between 3rd and 4th toes.
Patients present with pain on walking, well-localized and patients wearing shoes note that taking the shoes off relieves the pain. Some patients feel sitting cross legged causing pain.
Injection of a local anesthetic through the deep transverse metatarsal ligament can confirm the diagnosis by anesthetizing the neuroma.
A pain provocation test of the interdigital space from the plantar side is the Hohmann maneuver.
The reproduction of pain with this maneuver indicates the presence of a neuroma or a stress fracture.
Further irritation of the nerve may be produced by reciprocally moving the first and fifth metatarsals up and down in opposite directions. If this compression of the metatarsal heads reproduces the patient’s characteristic pain, it is highly suggestive of the presence of an interdigital neuroma.
Mahadevan D, Venkatesan M, Bhatt R, Bhatia M. Diagnostic Accuracy of Clinical Tests for Morton’s Neuroma Compared With Ultrasonography. J Foot Ankle Surg. 2015 Jul-Aug;54(4):549-53. doi: 10.1053/j.jfas.2014.09.021. PMID: 25432459.
MULDER JD. The causative mechanism in morton’s metatarsalgia. J Bone Joint Surg Br. 1951 Feb;33-B(1):94-5. doi: 10.1302/0301-620X.33B1.94. PMID: 14814167.
Clinical Tests for the Musculoskeletal System 3rd Edition.
Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.