American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first-line treatment for Morton neuroma?

1. Surgical removal

2. Metatarsal padding and broad-toed footwear

3. Glucocorticoid injections exclusively

4. Excessive rest and immobilization

The correct answer is: Metatarsal padding and broad-toed footwear

The first-line treatment for Morton neuroma involves the use of metatarsal padding and broad-toed footwear. This approach is aimed at reducing pressure on the affected nerve, which is typically compressed between the metatarsal bones. By utilizing broader shoes, there is increased space in the toe box, which helps alleviate the symptoms associated with Morton neuroma, such as pain and discomfort in the forefoot. Metatarsal padding serves to redistribute weight and provide cushioning, further minimizing irritation to the affected area. This conservative management is often effective in relieving symptoms, allowing patients to maintain their daily activities while potentially delaying or avoiding more invasive treatments like surgery. Other treatment options, such as glucocorticoid injections, might be considered after conservative measures if symptoms persist, but they aren't the first-line treatment due to potential complications with repeated injections. Surgical removal is typically reserved for cases where non-surgical interventions fail after an adequate trial. Resting and immobilizing the foot excessively may provide temporary relief, but it is not a practical long-term strategy and could lead to muscle weakening and stiffness. Thus, the use of metatarsal padding and appropriate footwear is central to managing Morton neuroma effectively.