Morton's neuroma - Clínica San Román

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.

Características
Manifestaciones

Characteristics and origin

– 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 on compression of the affected intermetatarsal space.
– DiagnosisDiagnosis is based on clinical history and physical examination. 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 for Morton’s Neuroma

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.

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 nerve compression.

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 restore foot function and avoid complications.
– Clinical and radiological follow-up: To ensure proper consolidation and recovery.