What are the key clinical features that differentiate Morton's neuroma from other causes of forefoot pain?

Morton's neuroma is primarily differentiated from other causes of forefoot pain by its characteristic clinical features: patients typically report sharp, burning pain localized in the plantar aspect between the third and fourth metatarsal heads, often described as a sensation of a pebble or a fold in the shoe. This pain is frequently exacerbated by weight-bearing activities and tight footwear, and relieved by rest or removing shoes. On examination, a positive Mulder’s click—a palpable or audible click when squeezing the forefoot—is a key diagnostic sign. Additionally, there may be tenderness on palpation in the intermetatarsal space without signs of inflammation or deformity. Unlike other causes of metatarsalgia, Morton's neuroma does not usually present with swelling or systemic symptoms. These features help distinguish it from other causes such as metatarsal stress fractures, arthritis, or bursitis, which may have more diffuse pain, swelling, or signs of inflammation ¹ (Afonso et al., 2023).

In summary, the key differentiators are the localized burning pain between specific metatarsal heads, the presence of Mulder’s click, and the absence of inflammatory signs, which are less typical in other forefoot pathologies ¹ (Afonso et al., 2023).