PLAB 2 NewCase_1: Morton's Neuroma
- examiner mla
- Oct 28, 2024
- 3 min read
Updated: Nov 6, 2024
1. Which of the following are common presenting symptoms of Morton's neuroma? (Select all that apply.)
A) Sharp pain between the toes
B) Swelling over the ankle
C) Numbness or tingling in the toes
D) A clicking sensation when walking
Answer
A) Sharp pain between the toes
C) Numbness or tingling in the toes
D) A clicking sensation when walking
Explanation:
Morton's neuroma commonly presents with sharp or burning pain between the toes, usually between the third and fourth toes. Patients may also experience numbness or tingling in the toes and a clicking sensation known as Mulder's click when the neuroma is palpated.
2. How might Morton's neuroma impact a patient's daily life? (Select all that apply.)
A) Difficulty wearing tight shoes
B) Increased pain when standing or walking
C) Limitation in ankle movement
D) Interference with sports activities
Answer
A) Difficulty wearing tight shoes
B) Increased pain when standing or walking
D) Interference with sports activities
Explanation:
Patients with Morton's neuroma often find that tight or narrow shoes exacerbate their symptoms. Prolonged standing or walking can increase pain, and physical activities, especially those involving running or jumping, may be limited due to discomfort.
3. What are common patient complaints during daily activities with Morton's neuroma? (Select all that apply.)
A) Pain relieved by removing shoes
B) Difficulty climbing stairs
C) Feeling of walking on a pebble
D) Morning stiffness in the toes
Answer
A) Pain relieved by removing shoes
C) Feeling of walking on a pebble
Explanation:
Patients often report that removing shoes relieves pain and describe a sensation of walking on a pebble or marble. Difficulty climbing stairs and calf cramping are not typical complaints. Morning stiffness is more associated with arthritic conditions.
4. Which factors can contribute to the development of Morton's neuroma? (Select all that apply.)
A) Wearing high-heeled shoes
B) Flat feet or over pronation
C) Repetitive high-impact sports
D) Diabetes mellitus
Answer
A) Wearing high-heeled shoes
B) Flat feet or overpronation
C) Repetitive high-impact sports
Explanation:
High heels and narrow shoes compress the forefoot. Flat feet or over pronation alter foot mechanics, and high-impact sports increase stress on the metatarsal area. Diabetes can cause neuropathy but is not a direct cause of Morton's neuroma. Smoking is not a recognized risk factor.
5. What are the possible differential diagnoses for Morton's neuroma? (Select all that apply.)
A) Metatarsal stress fracture
B) Plantar fasciitis
C) Rheumatoid arthritis
D) Tarsal tunnel syndrome
Answer
A) Metatarsal stress fracture
B) Plantar fasciitis
D) Tarsal tunnel syndrome
E) Peripheral neuropathy
Explanation:
Differential diagnoses include metatarsal stress fractures (which cause forefoot pain), plantar fasciitis (heel pain), tarsal tunnel syndrome (nerve compression causing foot pain), and peripheral neuropathy (nerve damage causing numbness and tingling). Rheumatoid arthritis can affect the foot but typically involves joint swelling and systemic symptoms.
6. Which investigations are useful in diagnosing Morton's neuroma? (Select all that apply.)
A) X-ray of the foot
B) Ultrasound imaging
C) MRI scan
D) Nerve conduction studies
Answer
A) X-ray of the foot
B) Ultrasound imaging
C) MRI scan
Explanation:
Ultrasound and MRI are effective imaging modalities for visualizing Morton's neuroma. X-rays may rule out bone fractures but do not show neuromas. Nerve conduction studies are less helpful, and blood tests are not diagnostic for this condition.
7. During physical examination, which signs are indicative of Morton's neuroma? (Select all that apply.)
A) Mulder's sign (clicking sensation)
B) Swelling over the metatarsal heads
C) Positive Tinel's sign at the ankle
D) Tenderness between the third and fourth toes
Answer
A) Mulder's sign (clicking sensation)
D) Tenderness between the third and fourth toes
Explanation:
Mulder's sign is elicited by squeezing the foot and palpating the interspace, causing a clicking sensation and pain. Tenderness between the toes is common. Swelling over the metatarsal heads and decreased pulses are not typical. A positive Tinel's sign at the ankle suggests tarsal tunnel syndrome.
8. Which examination techniques are useful in assessing Morton's neuroma? (Select all that apply.)
A) Palpation of the interdigital spaces
B) Checking ankle reflexes
C) Squeeze test of the forefoot
D) Assessing gait and footwear
Answer
A) Palpation of the interdigital spaces
C) Squeeze test of the forefoot
D) Assessing gait and footwear
Explanation:
Palpation can elicit tenderness, and the squeeze test may reproduce symptoms. Observing gait and footwear can provide insights into contributing factors. Checking ankle reflexes and leg length are less relevant.
9. How would you explain Morton's neuroma to a patient in layman's terms? (Select all that apply.)
A) "A small, harmless nerve growth between your toes."
B) "Inflammation in your big toe joint."
C) "A nerve in your foot is pressured, causing pain."
D) "Arthritis affecting foot bones."
Answer
A) "A small, harmless nerve growth between your toes."
C) "A nerve in your foot is pressured, causing pain."
E) "Thickened cushioning between bones irritates a nerve."
Explanation:
These explanations accurately describe Morton's neuroma in simple terms. It involves thickening of nerve tissue causing irritation. It is not arthritis or inflammation of the big toe joint.
10. What lifestyle modifications can help manage Morton's neuroma? (Select all that apply.)
A) Wearing wide, comfortable shoes
B) Using custom orthotic inserts
C) Increasing high-impact activities
D) Applying ice to reduce pain
Answer
A) Wearing wide, comfortable shoes
B) Using custom orthotic inserts
D) Applying ice to reduce pain
Explanation:
Lifestyle changes include wearing shoes with a wide toe box, using orthotics to relieve pressure, and applying ice to reduce symptoms. Increasing high-impact activities may worsen symptoms, and prolonged bed rest is unnecessary.
11. What is the primary goal in managing Morton's neuroma? (Select all that apply.)
A) Relieve pressure on the affected nerve
B) Cure the condition with antibiotics
C) Reduce inflammation and pain
D) Improve foot biomechanics
Answer
A) Relieve pressure on the affected nerve
C) Reduce inflammation and pain
D) Improve foot biomechanics
Explanation:
Management aims to relieve nerve pressure, reduce symptoms, and correct foot mechanics to prevent recurrence. Morton's neuroma is not an infection or a precancerous condition, so antibiotics and cancer prevention are not relevant.
12. Which medications might be prescribed for Morton's neuroma? (Select all that apply.)
A) Nonsteroidal anti-inflammatory drugs (NSAIDs)
B) Corticosteroid injections
C) Antibiotics
D) Antidepressants
Answer
A) Nonsteroidal anti-inflammatory drugs (NSAIDs)
B) Corticosteroid injections
Explanation:
NSAIDs can help reduce pain and inflammation. Corticosteroid injections directly into the affected area can alleviate symptoms. Antibiotics are not indicated unless there's an infection. Antidepressants and topical capsaicin are not standard treatments.
13. In addition to lifestyle changes and medication, what other treatments may be necessary for Morton's neuroma? (Select all that apply.)
A) Physical therapy
B) Surgical removal of the neuroma
C) Radiation therapy
D) Nerve decompression surgery
Answer
A) Physical therapy
B) Surgical removal of the neuroma
D) Nerve decompression surgery
Explanation:
Physical therapy can help manage symptoms. If conservative treatments fail, surgical options like neuroma excision or nerve decompression may be considered. Radiation therapy is not used, and while acupuncture may provide relief for some, it's not a standard treatment.
14. What safety netting advice should be given to a patient with Morton's neuroma? (Select all that apply.)
A) "Return if symptoms worsen or don’t improve."
B) "Get help if you develop foot numbness."
C) "No follow-up needed unless other health issues."
D) "Watch for infection signs after injections."
Answer
A) "Return if symptoms worsen or don’t improve."
B) "Get help if you develop foot numbness."
D) "Watch for infection signs after injections."
Explanation:
Patients should be advised to report worsening symptoms, new neurological signs, or signs of infection. Regular follow-up may be necessary, and changes in symptoms should not be ignored.
15. Should a referral be made for a patient with Morton's neuroma, and to which specialist? (Select all that apply.)
A) Yes; refer to an orthopedic surgeon
B) Yes; refer to a neurologist
C) Yes; refer to a podiatrist
D) No; manage entirely in primary care
Answer
A) Yes; refer to an orthopedic surgeon
C) Yes; refer to a podiatrist
Explanation:
Referral to an orthopedic surgeon or a podiatrist is appropriate for specialized management, especially if surgical intervention is considered. A neurologist or rheumatologist is less commonly involved unless there are additional neurological or rheumatological concerns.
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