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.
| Origin | Medial plantar nerve (first to third) and superficial branch of the lateral plantar nerve (fourth) |
|---|---|
| Course | Run distally in the intermetatarsal spaces under the plantar aponeurosis and divide near the metatarsal heads, deep to the deep transverse metatarsal ligament, into proper plantar digital nerves |
| Sensory |
|
Morton neuroma is perineural fibrosis of a common plantar digital (interdigital) nerve, most often the third (between the 3rd and 4th metatarsal heads) and less often the second, caused by repeated compression against the deep transverse metatarsal ligament. It produces burning forefoot pain radiating to the adjacent toes, worse in tight or high-heeled shoes, with a Mulder click on squeezing the metatarsal heads and tenderness in the web space. Ultrasound or MRI shows the enlarged nerve. Treatment starts with wide footwear, a metatarsal pad and corticosteroid injection; resistant cases need neurectomy, usually through a dorsal incision, as a plantar incision gives direct access but can leave a painful scar.
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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