Transient morton’s toe: An uncommon presentation of a common clinical condition

Abstract

Herpes zoster (Shingles) is a result of reactivation of the Varicella-zoster virus (VZV) in dorsal root ganglia (DRG) after a long latency period following a primary infection (chickenpox). A Morton's toe or neuroma is an enlarged common plantar nerve, usually in the third web space. Our patient, a 52 year old male, presented with an initial clinical and radiological picture of Morton’s toe. He however went on to develop characteristic vesicular rash of Herpes zoster over L5 dermatome within 48 hours of onset of forefoot pain signifying a temporal association which responded dramatically to antiviral medication. The clinical features mimicking Morton’s toe were probably due to the already compromised/ scarred inter digital space secondary to an old injury. This peculiar case, depicting a clinical presentation of Herpes zoster in the prodromal phase, has not been reported in literature till date. Knowledge of such an association would help clinicians in anticipating Herpes zoster as one of the differential diagnoses in a case of Morton’s toe and manage it accordingly. The rapid and substantial recovery in the patient’s forefoot symptomatology along with skin lesion following the initiation of antiviral therapy highlights the fact that the clinically apparent Morton’s toe was a manifestation of underlying Herpes zoster rather than a true inter digital neuroma.