Morton's neuroma
Treatment of Morton's neuroma
Morton’s neuroma is a painful condition affecting the common plantar digital nerve, usually in the third and fourth intermetatarsal space.
It is characterized by a sensation of sharp pain, burning or cramping that may radiate into the toes.
The following is a detailed description of Morton’s neuroma, its etiology, clinical manifestations, diagnoses and a comprehensive review of possible treatments.
- Etiopathogenesis
- Morton’s neuroma is a compression neuropathy that occurs when the common plantar digital nerve becomes irritated and thickened due to pressure between the metatarsal bones.
This compression may be associated with several factors:
- Foot anatomy: A flat foot or pronated forefoot may predispose to increased pressure on the nerve.
- Inappropriate footwear: High-heeled or narrow shoes that compress the forefoot.
- Repetitive trauma: Activities that involve constant pressure on the forefoot, such as running or jumping.
Clinical Manifestations
Typical symptoms include:
- Acute pain: Especially when walking or wearing certain types of footwear.
- Paresthesias: Tingling sensation or numbness in the fingers.
- Cramps: Cramp-like pain radiating to the interdigital spaces.
- Mulder’s sign: Pain and a palpable snap when compressing the affected intermetatarsal space.
Complementary tests include:
- X-rays: To rule out other causes of metatarsal pain.
- Magnetic Resonance Imaging (MRI) and Ultrasound: To visualize nerve thickening and rule out other masses.
- Electromyography: Although less common, it can help confirm the diagnosis by evaluating nerve conduction.
Treatments
Conservative Treatments
1. Hygienic-Postural Measures:
- Appropriate footwear: Use of wide and flat shoes.
- Orthotics: Customized insoles to redistribute pressure on the foot.
2. Medications:
- Analgesics and Anti-inflammatories: To control pain and inflammation.
- Infiltrations: Injections of corticosteroids and local anesthetics to reduce inflammation and relieve pain.
3. Physical therapy:
- Stretching exercises: To relieve pressure on the nerve.
- Massage and Manual Therapies: To reduce soft tissue tension.
Surgical Treatments
When conservative treatments fail, surgical options are considered:
1. Neurolysis:
Transverse Intermetatarsal Ligament Release: This procedure relieves pressure on the nerve without removing it.
Neurectomy:
Extirpation of the Affected Nerve: Indicated in severe or recurrent cases.
It involves the removal of the thickened nerve segment.
3. Osteotomies:
Metatarsal Osteotomies: performed in combination with ligament release to modify the position of the metatarsal and reduce compression on the nerve.
Postoperative
After surgery, specific care must be followed to ensure proper recovery:
- Post-surgical bandage and footwear: To protect the foot and allow proper healing.
- Rehabilitation: Physiotherapy to recover foot function and avoid complications.
- Clinical and radiological follow-up: To ensure correct consolidation and recovery.
Conclusion
Morton’s neuroma is a treatable condition with a combination of conservative measures and, in resistant cases, surgical interventions.
The choice of treatment depends on the severity of symptoms, response to initial therapies and individual patient characteristics.
A thorough evaluation and a multidisciplinary approach are essential to achieve the best clinical outcome.
In the San Roman Podiatric Clinic we have a long experience in the treatment of Morton’s Neuroma, we apply a conservative treatment with custom orthopedic insoles, appropriate footwear, and as a last resort by means of chemical neurolysis.
We have the latest technology for the diagnosis of neuroma, using 4D EchoDoppler equipment that allows us to diagnose and treat with chemical neurolysis by means of a guided needle.
This minimally invasive technique with 4D EchoDoppler allows the patient to return to daily activities immediately.
