The common plantar digital nerves are the terminal branches of the medial and lateral plantar nerves passing distally between the metatarsal heads in the intermetatarsal spaces. They divide at the distal edge of the deep transverse metatarsal ligament into the proper plantar digital nerves supplying adjacent toe surfaces. The third common digital nerve (between the 3rd and 4th metatarsal heads) receives contributions from both the medial and lateral plantar nerves, making it larger and more tethered than the others.
Morton neuroma is a perineural fibrosis of the common plantar digital nerve, most commonly the third (between 3rd and 4th metatarsal heads), caused by repetitive compression against the edge of the deep transverse metatarsal ligament. It produces burning forefoot pain radiating to the 3rd and 4th toes, a palpable Mulder click on lateral compression, and eventual permanent numbness of the adjacent toe surfaces. Treated by metatarsal pad offloading, corticosteroid injection, alcohol sclerosing injections, or surgical neurectomy.
Perineural fibrous degeneration of the third common plantar digital nerve at the 3rd-4th intermetatarsal space from repetitive ligament compression produces burning forefoot pain, toe paraesthesia, and Mulder sign on lateral metatarsal compression, managed by orthotics, corticosteroid injection, or surgical neurectomy for refractory cases.
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