Dawaa Reference

acute

Morton's Neuroma

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 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 against2 documents
  • MSF Essential Drugs 2024 - paracetamol (oral)
  • SmPC section 4.2, https://www.medicines.org.uk/emc/product/4560/smpc

Verified date2026-08

Presentation reference

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

SourceStatPearls "Morton Neuroma" - disease-level clinical article

Presentation findings are traced to the source above.

1

PARACETAMOL

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

1 g three or four times daily, maximum 4 g in 24 hours - As needed for pain or fever

Paediatric dose

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.)

Dose by weight
3kg45 mg/dose
4kg60 mg/dose
5kg75 mg/dose
6kg90 mg/dose
7kg105 mg/dose
8kg120 mg/dose
9kg135 mg/dose
10kg150 mg/dose
11kg165 mg/dose
12kg180 mg/dose
13kg195 mg/dose
14kg210 mg/dose
15kg225 mg/dose
16kg240 mg/dose
17kg255 mg/dose
18kg270 mg/dose
19kg285 mg/dose
20kg300 mg/dose
21kg315 mg/dose
22kg330 mg/dose
23kg345 mg/dose
24kg360 mg/dose
25kg375 mg/dose
26kg390 mg/dose
27kg405 mg/dose
28kg420 mg/dose
29kg435 mg/dose
30kg450 mg/dose
31kg465 mg/dose
32kg480 mg/dose
33kg495 mg/dose
34kg500 mg/dose (capped)
35kg500 mg/dose (capped)
36kg500 mg/dose (capped)
37kg500 mg/dose (capped)
38kg500 mg/dose (capped)
39kg500 mg/dose (capped)
40kg500 mg/dose (capped)
41kg500 mg/dose (capped)
42kg500 mg/dose (capped)
43kg500 mg/dose (capped)
44kg500 mg/dose (capped)
45kg500 mg/dose (capped)
46kg500 mg/dose (capped)
47kg500 mg/dose (capped)
48kg500 mg/dose (capped)
49kg500 mg/dose (capped)
50kg500 mg/dose (capped)
Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP
2

IBUPROFEN

add-on - not a substitute

Strength400 mg

Formoral.solid

Adult dose and duration

200-400 mg PO Q6-8H PRN, max 1200 mg/day. - As needed, shortest effective course

Paediatric dose

For pain and fever 20 mg/kg/day in divided doses (including OTC use).

Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAJUANOFEN 400 MG 20 F.C. TABS.COPAD PHARMA5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.DELTA PHARMA3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETSSANOFI12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.SEDICO6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABSEIPICO42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.KAHIRA > ABBOTT LABORATORIES78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.EUROPEAN EGYPTIAN PHARM. IND.31.00 EGP
ANALGIPROF 400 MG 25 SACHETSEVA PHARMA37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidSANOFI2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)4.50 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.