Toe nerves !
The toe nerves are small digital nerves running along the sides of each toe, from both the sole and the top of the foot.
Official name: Common plantar digital branches of medial plantar nerve
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What it is
Small nerves (digital nerves) running along each toe. They come from the plantar nerves under the foot and from the fibular nerves on top.
What it does
Carry feeling from the toes.
Key facts
- Roots
- L4–S2 (via plantar, fibular and sural nerves)
- Moves
- None (purely sensory, cutaneous)
- Feeling from
- Plantar digital nerves: sole side and nail beds; dorsal digital nerves: dorsum; Morton neuroma usually in 3rd web space
Relations
- Course
- The common plantar digital nerves (from the medial plantar nerve to the first three web spaces, from the lateral plantar nerve to the fourth) run forward between the slips of the plantar aponeurosis, pass under the deep transverse metatarsal ligament and split into proper digital nerves along the facing sides of two toes
- Deep
- The deep transverse metatarsal ligament and the intermetatarsal bursae, dorsal to them at the metatarsal heads
- Superficial
- The plantar fat pad and slips of the plantar aponeurosis, then the skin of the sole
How to find it
The plantar digital nerves run along the plantar-medial and plantar-lateral sides of each toe, the dorsal ones along the dorsal sides. The common plantar digital nerves lie in the web spaces, between and just in front of the metatarsal heads, where they are reached for injection and surgery.
Examination
- Mulder's click: squeezing the metatarsal heads together while pressing the web space from the sole reproduces pain and a palpable click in Morton neuroma
- Web-space compression: pressing between two metatarsal heads reproduces burning toward the adjacent toes
- Light touch on the sides of the toes: numbness of the two facing sides of adjacent toes localises a lesion to one web-space nerve
- Monofilament testing on the toes and forefoot screens for loss of protective sensation in diabetes
On imaging
The digital nerves are not seen on radiographs. Ultrasound and MRI are used when a Morton neuroma is suspected: a small mass between the metatarsal heads, most often in the third web space, at the level of the deep transverse metatarsal ligament. On ultrasound it is hypoechoic, and squeezing the forefoot during the scan may reproduce the pain and a click (sonographic Mulder sign).
Common problems
- Morton's neuroma: a thickened, irritated nerve between the toes, most often the third and fourth. It causes burning, numbness or a feeling of a pebble in the shoe.
- Narrow or high-heeled shoes make it worse.
- Numbness from diabetes often starts in the toes.
How it is diagnosed
A physical exam (squeezing the forefoot); ultrasound or MRI; sometimes a test injection.
Treatment
- Wider, lower shoes and pads that spread the metatarsals.
- Injections to calm the nerve.
- Surgery to remove the nerve or release the ligament pressing on it, if other treatments fail.
Clinical notes
- Excision of a Morton neuroma, by a dorsal or a plantar approach, leaves the facing sides of the two toes numb
- Digital nerves can be cut in toe lacerations and in bunion or hammertoe surgery, leaving one side of a toe numb
Anatomical variants
- A communicating branch from the lateral plantar nerve usually joins the common plantar digital nerve of the third web space; its presence and size vary, and it is one proposed reason why Morton neuroma favours that space
Related conditions
Test yourself
Think of the answer, then tap the question to see it.
What is a Morton neuroma, and where does it form?
Fibrous thickening of a common plantar digital nerve where it passes under the deep transverse metatarsal ligament, usually in the third web space.
What is Mulder's click?
Squeezing the metatarsal heads together while pressing the web space from the sole reproduces pain and a palpable click in Morton neuroma.
How many digital nerves does each toe have, and what does a digital block target?
Four: two plantar and two dorsal; the block places anaesthetic on both sides of the toe base to reach all four.
Educational information, not medical advice. For any symptom, see a health professional.
Its names
- Official Latin (TA2)
- rami digitales plantares communes nervi plantaris medialis; rami digitales plantares communes nervi plantaris lateralis; rami digitales dorsales nervi fibularis superficialis TA2 6591
- Official Spanish (DeCS)
- Nervios digitales plantares y dorsales del pie
- English (TA2)
- Common plantar digital branches of medial plantar nerve
- Also called
- common medial plantar digital nerves · common lateral plantar digital nerves · dorsal digital nerves of foot · nervi digitales plantares communes
Related
Sources: Terminologia Anatomica (TA2); Anatomy, Bony Pelvis and Lower Limb, Foot Nerves.
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Representative model, for educational purposes only.
