Statement of Principles
concerning
 
MORTON'S METATARSALGIA
No. 92 of 2010
 
for the purposes of the
 
Veterans’ Entitlements Act 1986
and
Military Rehabilitation and Compensation Act 2004
           
Title
1.         This Instrument may be cited as Statement of Principles concerning Morton's metatarsalgia No. 92 of 2010.
 
Determination
2.         This Statement of Principles is determined by the Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the VEA).
 
Kind of injury, disease or death
3.         (a)        This Statement of Principles is about Morton's metatarsalgia and death from Morton's metatarsalgia.
(b)              For the purposes of this Statement of Principles, "Morton's metatarsalgia" (also known as Morton's neuroma) means a neuropathy of the interdigital plantar nerve, most commonly in the second or third intermetatarsal space, due to entrapment or irritation of the nerve between the metatarsal heads. The condition is characterised by pain and numbness of the forefoot, which may radiate to the toes.
(c)              Morton's metatarsalgia attracts ICD-10-AM code G57.6.
(d)              In the application of this Statement of Principles, the definition of "Morton's metatarsalgia" is that given at paragraph 3(b) above.
 
Basis for determining the factors
4.         The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that Morton's metatarsalgia and death from Morton's metatarsalgia can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the Military Rehabilitation and Compensation Act 2004 (the MRCA).
 
Factors that must be related to service
5.         Subject to clause 7, at least one of the factors set out in clause 6 must be related to the relevant service rendered by the person.
 
Factors
6.         The factor that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting Morton's metatarsalgia or death from Morton's metatarsalgia with the circumstances of a person’s relevant service is:
 
(a)                wearing footwear which tightly restricts the forefoot of the affected foot, for at least four hours per day on more days than not, for the one year before the clinical onset of Morton's metatarsalgia; or
 
(b)               having an injury to the foot which damages or compresses the interdigital nerve within the affected intermetatarsal space, within the one year before the clinical onset of Morton's metatarsalgia; or
 
(c)                undergoing surgery to the foot which damages or compresses the interdigital nerve within the affected intermetatarsal space, within the one year before the clinical onset of Morton's metatarsalgia; or
 
(d)               having a biomechanical abnormality of the foot which damages or compresses the interdigital nerve within the affected intermetatarsal space, at the time of the clinical onset of Morton's metatarsalgia; or
 
(e)                having a condition as specified, which damages or compresses the interdigital plantar nerve within the affected intermetatarsal space, at the time of the clinical onset of Morton's metatarsalgia; or
 
(f)                 wearing footwear which tightly restricts the forefoot of the affected foot, for at least four hours per day on more days than not, for the one year before the clinical worsening of Morton's metatarsalgia; or
 
(g)                having an injury to the foot which damages or compresses the interdigital nerve within the affected intermetatarsal space, within the one year before the clinical worsening of Morton's metatarsalgia; or
 
(h)                undergoing surgery to the foot which damages or compresses the interdigital nerve within the affected intermetatarsal space, within the one year before the clinical worsening of Morton's metatarsalgia; or
 
(i)                  having a biomechanical abnormality of the foot which damages or compresses the interdigital nerve within the affected intermetatarsal space, at the time of the clinical worsening of Morton's metatarsalgia; or
 
(j)                 having a condition as specified, which damages or compresses the interdigital plantar nerve within the affected intermetatarsal space, at the time of the clinical worsening of Morton's metatarsalgia; or
 
(k)               inability to obtain appropriate clinical management for Morton's metatarsalgia.
 
Factors that apply only to material contribution or aggravation
7.         Paragraphs 6(f) to 6(k) apply only to material contribution to, or aggravation of, Morton's metatarsalgia where the person’s Morton's metatarsalgia was suffered or contracted before or during (but not arising out of) the person’s relevant service.
 
Inclusion of Statements of Principles
8.         In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.
 
Other definitions
9.         For the purposes of this Statement of Principles:
 
"a biomechanical abnormality" means abnormal foot function or an acquired foot pathology, such as:
(a)                claw toes;
(b)               hallux valgus;
(c)                hammer toes;
(d)               insufficiency of the first ray of the foot;
(e)                overloading of the metatarsal heads;
(f)                 overpronation of the foot on propulsion;
(g)                pes cavus; or
(h)                pes planus;
 
"a condition as specified" means one of the following disorders affecting the metatarsal region of the foot:
(a)                an infection;
(b)               an inflammatory arthritis; or
(c)                a space occupying lesion;
 
"death from Morton's metatarsalgia" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s Morton's metatarsalgia;
 
"ICD-10-AM code" means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM), Seventh Edition, effective date of 1 July 2010, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 978 1 74210 154 5;
 
"relevant service" means:
(a)                operational service under the VEA;
(b)               peacekeeping service under the VEA;
(c)                hazardous service under the VEA;
(d)               warlike service under the MRCA; or
(e)                non-warlike service under the MRCA;
 
"terminal event" means the proximate or ultimate cause of death and includes:
(a)               pneumonia;
(b)              respiratory failure;
(c)              cardiac arrest;
(d)               circulatory failure; or
(e)               cessation of brain function.
 
Date of effect
10.       This Instrument takes effect from 10 November 2010.
 
Dated this       twenty-seventh       day of              October            2010
 
 
The Common Seal of the                  )
Repatriation Medical Authority       )
was affixed to this instrument          )
in the presence of:                            )
 
KEN DONALD
CHAIRPERSON