Morton shoe inserts

Morton's neuroma results from compression, irritation, and inflammation of the nerve between the toes.

Surgical removal of Morton's neuroma

Without treatment, the condition develops rapidly, and the sharp, throbbing pain gets worse with each passing day. The pathology often limits the movement of the limbs, making walking or sports impossible. Even special orthopedic shoes do not help to relieve the pain.

Self-treatment of Morton's neuroma is contraindicated. The use of folk remedies, ointments, creams and lotions can aggravate the course of the disease and lead to disability from loss of motor function.

Operation of Morton's neuroma

Morton's neuroma excision involves surgically removing the thickened sheath of the supporting nerve in the area between the metatarsal bones. At the Ortomed Clinic, the procedure is performed under local anesthesia and includes a smooth skin incision, transection of the subcutaneous tissue, severing and removal of the neuroma, suturing and drainage of the wound. In the postoperative period, a short stay in hospital is possible to reduce the risk of inflammatory complications and infection of the surgical wound, which, as a rule, does not exceed one day in a comfortable hospital.

There is no recurrence after the operation. The only side effect is a slight numbness at the surgical site.

causes of the disease

Several factors have a negative effect on the foot tissues and favor the development of Morton's toe syndrome.

• A trauma to the foot associated with compression of the nerve formations in the interdigital space;
• Transverse flatfoot, deforming the foot and disrupting its normal innervation;
• hematoma (soft tissue contusion) that puts pressure on the nerve;
• Chronic foot tissue infections;
• Obliterative diseases of the feet affecting blood supply;
• Prolonged physical exertion while standing (e.g. at work);
• Obesity, which gradually leads to foot deformity and plantar nerve compression.

The footwear worn by the patient also plays an important role in the development of Morton's neuroma. Tight, uncomfortable shoes and boots should not be bought - this leads to an interruption in the blood supply and innervation of the foot tissues.

As you can see, perineal fibrosis can be triggered by many different causes. Only an experienced surgeon can determine exactly what causes the disease and how to treat it.

How Morton's neuroma develops

Morton's neuroma most commonly develops between the third and fourth toes—the third space between the toes. The disease is usually unilateral. In rare cases, with rapid onset and early progression of periosteal fibrosis, the neuroma can develop bilaterally.

The main pathological factor in the development of the disease is excessive pressure exerted on the bones of the foot. The bones deform and change position, resulting in compression of the supporting nerve. An inflammatory process develops around the damaged tissue, culminating in the active growth of connective tissue in this area and its fusion with the bones and muscles of the foot. The fibers that make up the soleus nerve regrow, forming what are known as growth cusps and perriconcito spirals. The normal innervation of the foot is thus disturbed.

Diagnosis of Morton's neuroma

During the visit to the doctor, the doctor examines the foot and feels the most painful areas. For differential diagnosis and to clarify the diagnosis, an ultrasound, X-ray, MRI or CT scan of the ankles may be recommended.

Conservative method of treatment

This method is effective in the early stages of the disease, when the pain is not constant. Orthopedic insoles, special toe splints, loose-fitting footwear and a reduction in foot load are recommended to eliminate mechanical pressure factors and irritation of the interdigital nerve. Nonsteroidal anti-inflammatory drugs and local anesthetics can be given to relieve pain and inflammation in the area of the interdigital nerve. Corticosteroids in the form of drug blocks are also sometimes prescribed.

Physiotherapeutic treatments such as magnetotherapy, electrophoresis and acupuncture are actively used.

Surgical method of treatment

The surgical method is used when conservative therapy is unsuccessful.

The most gentle method is the excision of the transverse interosal ligament, which prevents the nerves from being severed. The operation is performed on an outpatient basis, and the patient can almost immediately walk around the house again on his heels. The downside is the possibility of recurrence.

The most radical method is removal of Morton's neurinoma with excision of the area of \u200b\u200bperiarticular fibrosis. This operation can also be performed on an outpatient basis, but a feeling of numbness in the foot may remain for a short time without affecting the supporting function of the foot.

A less commonly used surgical technique is to decompress the nerve and relocate the head of the 4th metatarsal through a minimally invasive distal osteotomy (artificial fracture).

Prevention of Morton's neuroma

A prevention of Morton's neuroma is not always possible. However, you can reduce the risk by changing your footwear. Shoes should not be too tight and should not press in the foot.

• Comfortable shoes with a wide toe box and a low heel should be worn.
• Use of orthopedic insoles for the midfoot compression area, which are selected individually.
• orthopedic bracket
• In some cases, wearing special orthopedic shoes is recommended.
• Nonsteroidal anti-inflammatory drugs like indomethacin, ibuprofen, and others are usually prescribed to reduce inflammation and pain.

When simple treatments are ineffective, steroidal drugs in combination with a local anesthetic can be given to the area of the neuroma. Dipropane, kenalog, or hydrocortisone are usually used for this purpose. Conservative treatment is usually successful in 80% of patients with Morton's neuroma.

surgical intervention

If several months of conservative treatment do not give a positive result, surgical treatment is performed, during which the neuroblastoma is removed or the nerve canal is expanded. These surgical procedures are usually performed under local anesthesia. If part of the nerve is removed along with the neuroblastoma, you may experience a little numbness after the surgery.

About Morton's neuroma

The forefoot is made up of a series of metatarsal bones that are replaced by the toe bones. The nerves that are responsible for sensing and supplying the side surfaces of the toes run between the metatarsal bones. A coronary thickening of the sheaths of one of these nerves is called Morton's neuroma. The thickening usually forms between the third and fourth fingers, more rarely between the second and third fingers, and very rarely between the first and second or fourth and fifth fingers. The mass may be palpable on palpation. It develops in the area of the enlarged part of the metatarsal, or first bone of the toe, so that it can be compressed by the bones and denser surrounding tissue during movement. Compression of the nerve causes pain of varying intensity, often severe, and the development of tunnel syndrome. Younger women (up to age 60) are most commonly affected.

Exactly how Morton's neuroma arises and develops is unknown. It is believed that regular micro-injuries lead to the destruction of the transverse interdigital ligament in the foot, it disintegrates into fibers and swells. The swelling of the tissue causes compression of the surrounding foot tissue, and the body forms a thickening of the nerve sheath and the formation of additional layers of connective tissue at the site of compression to protect the sensitive nerve and ensure its nutrition.

Triggers for the development of a Morton's neuroma are, among others.

• Various anomalies of foot structure (flat feet, metatarsal and phalangeal deformities, changes in nerve structure and location, etc.) or gait,
• circulatory disorders (nerve bruises, vascular disorders in the lower limbs),
• inflammatory, infectious and autoimmune diseases,
• Trauma,
• frequent wearing of uncomfortable shoes that constrict the foot too much (women who wear tight shoes with high heels are more at risk),
• overweight,
• Pregnancy,
• Excessive loading of the forefoot (excessive sport, heavy physical work),
• genetic predisposition.

symptoms

The foot balances on the 2nd metatarsal by increasing pressure on the foot 'like on a knife edge'. This leads to increased fatigue in the foot, lower leg, and back, weakness in the ankle, and shooting, shooting pain when walking. There may be a feeling that there is a foreign object between the toes. The pain usually subsides when shoes are removed and toes kneaded. With these symptoms, the foot should not be loaded with a narrow or high heel.

• Women. This can be caused by women wearing tight shoes and high heels. Wearing these shoes encourages movement of the foot bones in a way that increases the risk of Morton's neuroma.
• people who are overweight, the pressure can cause displacement of the metatarsal bones.

diagnosis

Diagnosis of Morton's neuroma is based on the characteristic symptoms and the localization of the pain in the foot. An important part of diagnosis is knowing the type of footwear worn by the patient. To determine a possible cause in the area of the foot, the doctor will interview the patient and ask about previous conditions such as arthritis, muscle or nerve disorders, or previous trauma.
To clarify the diagnosis, the doctor examines the foot. The doctor presses the soles of the feet with his fingers to find painful spots that are characteristic of Morton's neuroma. In some cases, the doctor may notice a numb area on the sole of the foot between the toes. Pain in multiple places on the same foot, e.g. B. between the second and third toes and the third and fourth toes are more characteristic of arthritis than Morton's neuroma.

A radiological exam is done to rule out other causes of tip pain, such as B. a fracture or arthritis. In some cases that are difficult to diagnose, an MRI is done.

symptoms

The foot balances on the 2nd metatarsal like a knife edge. This leads to increased fatigue in the foot, lower leg, and back, weakness in the ankle, and a burning, stabbing pain when walking. There may be a foreign body sensation between the toes. The pain usually subsides when shoes are removed and toes kneaded. With these symptoms, the foot should not be loaded with a narrow or high heel.

• Women. This can be caused by women wearing tight shoes and high heels. Wearing such shoes encourages movement of the foot bones in a way that increases the risk of Morton's neuroma.
• people who are overweight, the pressure can cause displacement of the metatarsal bones.

diagnosis

The diagnosis of Morton's neuroma is based on the characteristic symptoms and the localization of the pain in the foot. An important part of diagnosis is knowing the type of footwear worn by the patient. To determine a possible cause in the foot area, the doctor will interview the patient and ask about previous conditions such as arthritis, muscle or nerve disorders, or previous trauma.
To clarify the diagnosis, the doctor examines the foot. The doctor presses the soles of the feet with his fingers to find painful spots that are characteristic of Morton's neuroma. In some cases, the doctor may notice a numb area on the sole of the foot between the toes. Pain in multiple places on the same foot, e.g. B. between the second and third toes and the third and fourth toes are more characteristic of arthritis than Morton's neuroma.

A radiological exam is done to rule out certain other causes of tip pain, such as: B. a fracture or arthritis. In some diagnostically difficult cases, an MRI is performed.

Benefits of treatment at VALGO

Morton's neuroma is a benign pathology in which the longitudinal nerve in the foot is compressed by an overgrowth of fibrous tissue. The affected area is between the 3rd and 4th toe, less often between the 2nd and 3rd.

Morton's neuroma often develops against a background of transverse flatfoot and is sometimes accompanied by a valgus deformity. Women are more likely to be affected because they wear high-heeled shoes and shoes that are tight in the toe area. This circumstance leads to flat feet. This changes the position of the metatarsal bones and increases pressure on the nerves that supply this area of the foot. Morton's neuroma is also diagnosed in men. People who play sports suffer from this condition.

symptoms

Symptoms that are troublesome in Morton's neuroma.

• Stabbing pain that increases with prolonged walking or running. The symptoms subside at rest and during sleep. The area of pain is between the 3rd and 4th toes, often in the proximal part of the foot, closer to the toes.
• Paresthesia in the form of itching, burning - these symptoms are an indication of disturbed innervation.
• Unpleasant sensations when wearing shoes in the form of the presence of a non-existent object.

The neuroma develops slowly. Over time, the symptoms become more and more pronounced and significantly reduce the quality of life.

Symptoms and Diagnosis of Morton's Disease

The onset of symptoms begins with neurological deficits - numbness in 3-4 fingers, paresthesia (goose bumps), burning and pain. All these symptoms increase when wearing tight and uncomfortable shoes or after physical activity. They disappear at rest and after kneading the foot.

The symptoms can occur in episodes, but become more frequent and more pronounced as the disease progresses. A characteristic feature of Morton's neuroma is an increase in pain when transverse pressure is applied to the foot. In later stages, an oval thickening can be seen in the space between the heads of the third and fourth metatarsal bones.

However, the clinical findings are not always sufficient to make a clear diagnosis. An ultrasound examination of the soft tissues of the foot or an MRI examination is required to confirm the diagnosis. The choice of method is made by the attending physician depending on the specific situation.

How is Morton's metatarsalgia treated?

Treatment begins with conservative methods. To alleviate the symptoms of the disease, it is recommended not to wear tight shoes, give up high-heeled shoes and buy orthopedic shoes or insoles, which should be selected together with the doctor. It cannot cure the disease, but it can prevent its progression and reduce the occurrence of Morton's neuroma.

Widespread in the Treatment of Morton's neuroma Reflex therapy and physical therapy methods: hydrocortisone phonophoresis and magnetolaser therapy, local cryotherapy and intraoperative laser therapy.

The following drugs are used:

• Nonsteroidal anti-inflammatory drugs that can be administered systemically (as tablets or injections) or topically. Ointments are preferred as they have no systemic effects and no side effects (no gastrointestinal ulceration, no hypertension and no liver damage). This group of medicines reduces pain, swelling and inflammation, and other symptoms, but does not eliminate the neuroma itself;
• corticosteroids. These are used in the form of therapeutic drug blocks. This is the strongest group of anti-inflammatory drugs and has many side effects (high blood pressure, high blood sugar, can cause stomach and duodenal ulcers), but is relatively harmless when applied topically, but can eliminate inflammation in neuroblastoma and pain.

Surgical treatment is used when symptoms persist or the disease progresses despite treatment. The operation is usually performed on an outpatient basis and under local anesthesia. During the operation, not only the fibrous mass is removed, but also the nerve bed is enlarged, which is very important for the health of patients. Prevention of recurrence of Morton's metatarsalgia.

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