Neuralgia or benign neuromas can occur in any interphalangeal nerve, which travels below the phalanx and between the metatarsals, over the ball of the metatarsal and toward the distal end, innervating the toes. The third plantar interphalangeal nerve consists of branches of the medial and lateral plantar nerves, where neuromas (Morton’s neuromas) usually form. Unilateral neuromas are more common than bilateral ones, and are more common in women than men. Symptoms and signs of intermetatarsal neuroma Interdigital neuralgia is characterized by sudden pain radiating along one or more of the foot’s nerves to the ball or toe of the toe. This may be due to loss of the fat pad that protects the interphalangeal nerve in the foot, repeated mild trauma, or inappropriate shoe wear. Interdigital neuroma presents as a progressive benign thickening and enlargement around one or more interdigital nerves. In the early stages, patients with this neuroma complain only of mild pain or discomfort in the ball of the metatarsal area, most commonly in the area of the 4th metatarsal head. Sometimes there is a burning or pins and needles sensation. The patient may feel as if there is a stone in the ball of the metatarsal. The symptoms are usually more pronounced when wearing one style of shoe than another. As the disease progresses, the sensation can become more specific, often with a burning sensation radiating to the toes. During walking, it is often necessary to remove the shoes in order to relieve the pain. Diagnosis and treatment of intermetatarsal neuroma The diagnosis is based on a characteristic history and tenderness in the interdigital space on the bottom of the foot. When a neuroma is present, pressure with the thumb between the bones of the third and fourth toes often causes pain. The pain is usually relieved rapidly with appropriate footwear. Lidocaine injection is sufficient for relief of neuralgia alone; otherwise, perineural infiltration with a long-acting corticosteroid and local anesthetic is required for neuroma formation. Injections are made into the toe space in the dorsal plane of the metatarsophalangeal joint at a 45° angle to the foot and repeated 2-3 times at 1-2 month intervals. It is also more beneficial to use an orthosis of the foot, which should be treated as conservatively as possible before surgery. When conservative treatment is ineffective, surgical removal of the neuroma can be completely eradicated.