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Addressing Mortons Neuroma
30.05.2017 07:46
Overview

MortonA neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton?s neuroma, which occurs between the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma. ?Intermetatarsal? describes its location in the ball of the foot between the metatarsal bones. Neuromas may also occur in other locations in the foot. MortonThe thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage.

Causes

A Morton's neuroma commonly occurs due to repetitive weight bearing activity (such as walking or running) particularly when combined with tight fitting shoes or excessive pronation of the feet (i.e. "flat-feet"). The condition is also more common in patients with an unstable forefoot allowing excessive movement between the metatarsal bones. A Morton's neuroma can also occur due to certain foot deformities, trauma to the foot, or the presence of a ganglion or inflamed bursa in the region which may place compressive forces on the nerve.

Symptoms

Outward signs of Morton's neuroma, such as a lump, are extremely rare. Morton's neuroma signs and symptoms, which usually occur unexpectedly and tend to worsen over time, include, pain on weight bearing (while walking) - a shooting pain affecting the contiguous halves of two toes, which may be felt after only a short time (of weight bearing). Sometimes there may be a dull pain rather than a sharp one. Most commonly, pain is felt between the third and fourth toes. Typically, a patient will suddenly experience pain while walking and will have to stop and remove their shoe. Burning. Numbness. Parasthesia, tingling, pricking, or numbness with no apparent long-term physical effect. Commonly known as pins-and-needles. A sensation that something is inside the ball of the foot.

Diagnosis

Plain x-rays of the foot may demonstrate that one or more of the metatarsals are long (Figure #5). Not uncommonly, the second and/or third metatarsal may be long relative to the third or fourth. This can create a situation where excessive load is occurring in and around the vicinity of the interdigital nerve.

Non Surgical Treatment

Pain is the main reason that you seek treatment for a neuroma. Analgesics may help. Inflammation it best eased via ice therapy and techniques or exercises that deload the inflammed structures. Anti-inflammatory medications may help. Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include: ice, electrotherapy, acupuncture, deloading taping techniques, soft tissue massage and orthotics to offload the irritated nerve. One of the biggest factors in relieving pain may be changing or modifying your footwear. This may mean adding felt, foam or gel products to your shoe to help offload the area, or looking at avoiding tight fitting heels or shoes.Morton

Surgical Treatment

When conservative measures are unsuccessful, surgery can be a good choice in the treatment of Morton's neuroma. The operation for Morton's neuroma does not require an overnight hospital stay. The anesthetic used is an ankle block, which completely numbs the foot during the surgery. The physician removes the neuroma from an incision made on the top of the foot between the involved metatarsal heads. The nerve to the interspace is exposed and cut next to the metatarsal heads.

Prevention

To help reduce your chance of developing Morton's neuroma avoid wearing tight and/or high-heeled shoes. Maintain or achieve ideal body weight. If you play sports, wear roomy, properly fitting athletic footwear.
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