Morton’s Neuroma: everything you didn’t know

Morton’s disease (sometimes called Morton’s neuroma or Morton’s metatarsalgia) is characterized by a rapid onset of foot pain during physical exercise. The pain is often so strong that the sufferer must remove their shoes and rub the front of their foot.

WHAT IS MORTON’S DISEASE?

Metatarsalgia is discomfort at the front of the foot. Morton’s metatarsalgia is caused by pressure on the nerve in the metatarsal tunnel. In 1876, Morton described it. The III metatarsal tunnel (the space between the III and IV metatarsal heads) is the most affected nerve. The II and IV metatarsal tunnels are damaged less often. Only 2-3% of the time are two or more tunnels destroyed.

A alteration in the nerve between the third and fourth toes and through the foot’s ligaments causes the condition. Nerves can thicken through irritation, damage, or strain. Normal walking is difficult, if not impossible, and a shift in gait pattern might create discomfort.

CAUSES

Morton’s metatarsalgia is often caused by high-heeled or too-small shoes. Hyperextension of the toes (examples include sprinting and running uphill, as well as some vocations that involve longer squats) narrows the metatarsal tunnels, reducing the nerve’s space and increasing pressure on it, and is a key risk factor for Morton’s metatarsalgia. The swollen nerve becomes thicker and more sensitive to further damage, resulting to a neuroma.

Reduced ankle dorsiflexion mobility might be an inherent characteristic or the effect of shortening lower leg muscles and Achilles tendon.

Metatarsalgia is caused by diminished transverse arches, local foot deformities, and foot illness. Curled fingers can accompany metatarsalgia. Weaker muscles impact the direction of the load due to changes in the lower leg bones, the inclination ratio to the base, and the load force.

Morton’s neuroma can be caused by foot inflammation, heavy loads during intensive sports, benign lesions (lipomas), bad stride that strains nerves, trauma, and hematomas near nerve fibres.

Morton’s neuroma causes include Morton’s finger and flat feet.

Sports that exert pressure on the front of the foot or require tight footwear may also cause Morton’s neuroma (ballet).

Morton’s metatarsalgia affects women 5:1 more than males, with most instances between 15 and 50. Morton’s metatarsalgia is underrepresented in sports-medicine literature because it’s not sport-specific. Long-distance runners and dancers have it.

SYMPTOMS

Interdigital neuralgia is metatarsal or finger pain. Early neuralgia is usually unilateral and treated by wearing specific footwear. As the situation develops, Morton’s neuroma arises. Paraesthesia can make the pain feel like burning and tearing.

Pain and burning on the front, bottom, and toe “roots” are common symptoms. Walking, running, and wearing shoes increase this soreness. Toe numbness and pain are possible. Neuromas attack the 3rd and 2nd metatarsal spaces but can affect both and both legs.

Oblique toe joint alignment causes the second greatest foot pain. The foot’s oblique position, caused by a high or low arch, bends the toes. Skin thickens and corns form quickly when fingers are bent. Pain can persist up to an hour. Pain comes after prolonged standing or weight on the feet.

DIAGNOSIS

Any foot ailment requires a three-dimensional radiograph, even though the results are normal. A clinical exam is usually sufficient to diagnose. Neuromas can be felt as a circular thickening between the metatarsal heads. The examiner’s thumb should be between the metatarsal heads, in the metatarsal tunnel projection, and the index finger should be dorsal.

Squeezing the foot at the metatarsal heads can also cause pain and a click. Active or passive toe bending can be painful. X-rays and ultrasonography must rule out rheumatoid arthritis, tendinitis, and gout.

TREATMENT

Rest, comfortable shoes with a metatarsal pad, nonsteroidal antirheumatic drugs, corticosteroid injections, and physical therapy are common therapies. Surgical nerve removal or decompression is necessary if conservative treatment fails.

Under ultrasonography, infiltration straight into the neuroma yields better results. 62% of patients don’t report of pain after one ultrasound-guided injection, compared to “blind” injections. Only 15% of patients report a 50% improvement after one “blind” injection, and only 30% need three or four weekly injections to be symptom-free.

Physical therapy can relieve symptoms. Two options exist. Micro vibrations, laser light stimulation, and heat alleviate pain with ultrasound. Proprioceptive exercises eliminate pain in most patients. Shock wave therapy lowers pain receptor sensitivity and can be utilized alongside exercise.

Shockwave therapy causes:

  • Pain relief
  • Increased metabolism
  • Increased blood circulation (neovascularization)
  • Decreased calcification
  • Decreased muscular stress
  • Improved mobility
  • Connective tissue affects

Cryotherapy, therapeutic ultrasonography, and corticosteroid injections with local anaesthetics are popular physical therapies. Morton’s metatarsalgia can be controlled with proper footwear and physical therapy. It shouldn’t affect daily or athletic activity.

Avoid uncomfortable activities and massage the affected area with ice for 10 minutes several times a day. Continuing pain requires medical treatment.

Morton’s neuroma surgery is considered if non-surgical treatments fail. First, the ligament is severed to decompress the nerve. Pain requires complete nerve cutting. Incisions must be made at least 3 cm above the neuroma to avoid pain recurrence from insufficient cross-section. Reconstructing the transverse ligament can prevent head bone instability.

If non-surgical treatment (shoe change, orthopaedic insoles, and maybe corticosteroid injection with local anaesthesia) is successful, patients can return to work and sports in two to three weeks. The athlete may begin running six to eight weeks after neuroma surgery, with a full return to sports in three months.

HIGH-PERFORMANCE FOOTWEAR

Morton’s metatarsalgia causes undetected foot pain. Morton’s metatarsalgia patients should wear wider shoes without a higher heel. Low-heeled, wide-toed shoes are indicated for treatment. Use orthopedic insoles with metatarsal cushions to bend the toes and prevent overstretching.

Orthopedic insoles aren’t sold as finished products in stores. In addition to an orthopedist’s clinical evaluation, a computer analysis of gait and foot stress is required to manufacture an orthopedic insole nowadays. In addition to acquiring a footprint, the doctor should evaluate the patient’s footwear, both sports and every day, giving special attention to the soles.

DrLuigi medical footwear prevents and treats Morton’s neuroma. Extended-lasting Luigi shoes can aid people with leg and back pain, especially those whose occupations require long amounts of standing or walking. These shoes are appropriate for people with limited movement due to neurological problems due to their anatomical design, flexibility, softness, comfort, and low weight. Dr. Luigi medical shoes are: Static strong load helps chronic vascular diseases (long standing).

N.R.
17.06.2022.