# Morton's Neuroma - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · MSF Essential Drugs 2024 - paracetamol (oral) · Dixon M, Munir U, Tafti D. Morton Neuroma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: July 5, 2026. NBK470249. - Verified date: 2026-08 ## Verified against - MSF Essential Drugs 2024 - paracetamol (oral) - SmPC section 4.2, https://www.medicines.org.uk/emc/product/4560/smpc ## Treatment metadata - Paracetamol — 500 mg — oral.solid - Ibuprofen — 400 mg — oral.solid ## Complete treatment card ```text MORTON'S NEUROMA Sources: Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · MSF Essential Drugs 2024 - paracetamol (oral) · Dixon M, Munir U, Tafti D. Morton Neuroma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: July 5, 2026. NBK470249. Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Sole pain between the metatarsal heads, worse on walking or in tight or high-heeled shoes, eased by rest or taking the shoe off - The pain burns, stabs or tingles, shooting electrically into the toes - Some describe it as treading on a stone or a marble - Numbness and pins and needles between the toes come in less than half of cases [numbness · tingling] - After long walking it can spread to hindfoot or leg and bring cramps [muscle cramps] SIGNS - what you find (4) - Pressing the involved web space may reproduce the pain - Squeezing the forefoot side to side while palpating gives a crunch or click, the Mulder sign, useful but inconstant - Tenderness of the web space is the most sensitive sign of all - Test the metatarsophalangeal joint for instability too, since combined pathology is common TESTS (12) - The diagnosis normally rests on history and examination - Some surgeons put 1 to 2 mL of lidocaine into the web space as a diagnostic test - Take weight-bearing plain films to exclude bony mass, deformity, subluxation, dislocation or arthritis - Splaying of the distal intermetatarsal space with the toes diverging is the Sullivan sign - Films will also reveal a radio-opaque foreign body - Ultrasound is a useful aid in experienced hands - Some studies put ultrasound ahead of MRI in sensitivity for neuromas greater than 5 mm - Ultrasound also spots coexisting bursitis and steers a steroid injection - MRI confirms the diagnosis and excludes other pathology - On MRI a dumbbell soft-tissue lesion sits in the intermetatarsal space, low on T1, low or middling on T2 - On ultrasound it is a non-compressible, hypoechoic dumbbell lesion in that same space - Prefer MRI where neuromas are multiple or the joint unstable; thin slices read plantar plate disease well IF NOT THIS - what else fits (12) - Stress fracture of a metatarsal - Hammertoe deformity - Rheumatoid or another autoimmune arthritis - Osteoarthritis - A malignant growth or other tumour - Ganglion cyst, a foreign body, or a plantar wart - Thickened plantar skin, or wasting of the fat pad - Rupture or injury of the plantar plate - Flexor tendinitis, or a sprained metatarsophalangeal joint - Bursitis, or plantar fasciitis at its distal end - Diabetic or other stocking-glove peripheral neuropathy - Neuritis referred from the spine or sciatic nerve, or tarsal tunnel syndrome Source StatPearls "Morton Neuroma" - disease-level clinical article Status traced to the source above 1. PARACETAMOL [1st line] Adult 1 g three or four times daily, maximum 4 g in 24 hours - As needed for pain or fever Peds 15 mg/kg/dose [child max 500 mg] (Child 1 month and over: 15 mg/kg per dose, 3 or 4 times daily, maximum 60 mg/kg daily. Child under 1 month: 10 mg/kg per dose, 3 or 4 times daily, maximum 40 mg/kg daily. MSF's own weight table gives one 500 mg tablet three times daily from 30 kg to under 50 kg, so 500 mg is the per-dose ceiling; the 60 mg/kg daily total still applies.) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why Symptomatic relief of the pain and fever only. It does not treat the cause, and the dose is the same whatever the cause is. Caution Relief only - it does not treat what is causing the pain or fever. Check every other product the patient is taking for paracetamol; combination cold and flu preparations are the usual route to an accidental overdose. Administer with caution to patients with hepatic impairment. RED FLAG - Persistent symptoms despite footwear change, warranting referral for injection or surgery, or numbness spreading beyond the toes, suggesting an alternative neurological cause. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 2. IBUPROFEN [add-on - not a substitute] Adult 200-400 mg PO Q6-8H PRN, max 1200 mg/day. - As needed, shortest effective course Peds For pain and fever 20 mg/kg/day in divided doses (including OTC use). Source SmPC section 4.2, https://www.medicines.org.uk/emc/product/4560/smpc Why An anti-inflammatory analgesic for the pain and any inflammatory component. Symptomatic only; the dose does not change with the underlying diagnosis. Caution Relief only - it does not treat what is causing the pain. Take with or after food, and give gastroprotection if it is needed for more than a short course or the patient is over 65. Avoid in dehydration and in anyone not drinking - the kidney risk is highest there. Contraindicated in the last trimester of pregnancy. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)