Disclosures: Michelle Seymour, MD, PhD: No financial relationships or conflicts of interest

Case Description: Patient presented with an eight-month history of left foot pain anterior to the second and third metatarsal heads with weight bearing. There was no inciting event, and pain did not improve with arch support or changes in footwear. Examination was significant for tenderness with palpation anterior to the left second and third metatarsal heads and loss of vibration sensation to the tibial plateau bilaterally.

Setting: Academic musculoskeletal clinic

Patient: 57 year-old female with PMH ovarian cancer three years ago s/p taxol/carboplatin chemotherapy Assessment/

Results: Dynamic ultrasound revealed a baseline distance of 0.1 cm between the lower edge of the Morton neuroma (MN) and the metatarsal heads. When symptoms were reproduced by application of pressure using the ultrasound probe, the MN dropped to 0.08 cm below the plane of the metatarsal heads, a net movement of 0.18 cm. While maintaining this level of pressure, insertion of a silicone toe spacer between the 2nd and 3rd toes alleviated symptoms and raised the bottom edge of the MN to 0.2 cm above the metatarsal heads. With no pressure applied and the toe spacer in place, the bottom edge of the MN was 0.23 cm above the metatarsal heads.

Discussion: MN are interdigital neuromas of the foot that cause burning pain in the forefoot radiating to the toes with weight-bearing activities. As pressure is applied to the forefoot, the MN drops between the metatarsal heads, increasing pressure on the interdigital nerve. Silicone toe spacers are readily available over-the-counter and provide symptomatic relief. Dynamic ultrasound reveals that placement of a silicone toe spacer between the affected toes increases the distance between the MN and the plane of the metatarsal heads, reducing impingement and relieving symptoms.

Conclusion: By increasing the distance between the MN and the plane of the metatarsal heads, inexpensive silicone toe spacers can relieve pressure-related neuropathic symptoms.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/toe-spacer-relieves-morton-neuroma-symptoms-and-increases-distance-from-metatarsal-heads-a-case-report/