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What Causes Mortons Neuroma
05.06.2017 12:39
Overview

interdigital neuromaMorton's neuroma is named after Dr Morton who first described this condition in 1876. It is sometimes called Morton's metatarsalgia or interdigital neuroma. It is a condition that affects one of the common plantar digital nerves that run between the long bones (metatarsals) in the foot. It most commonly affects the nerve between the third and fourth metatarsal bones, causing pain and numbness in the third and fourth toes. It can also affect the nerve between the second and third metatarsal bones, causing symptoms in the second and third toes. Morton's neuroma rarely affects the nerve between the first and second, or between the fourth and fifth, metatarsal bones. It tends to affect only one foot. It is rare to get two neuromas at the same time in the same foot.

Causes

There are a number of common causes for Morton?s Neuroma, (though the condition can arise spontaneously for reasons still unknown). The Neuroma often occurs in response to irritation, pressure or traumatic injury to one of the digital nerves leading to the toes. A thickening of nerve tissue results as part of the body?s response to the irritation or injury. Abnormal foot movement used to compensate for bunions, hammertoes, flatfeet and other conditions can lead to irritation and development of Morton?s Neuroma. Pronation of the foot may cause the heads of the metatarsal bones to rotate slightly, thereby pinching the nerve running between the metatarsal heads. Chronic pressure or pinching causes the nerve sheath to enlarge, becoming increasingly squeezed, producing worsening pain over time, if not addressed. Morton?s Neuroma can be exacerbated when tight shoes providing little room for the forefoot are worn. Activities which over-pronate the foot (such as walking barefoot in sand) may increase the pain associated with Morton?s Neuroma, as will any high-impact activity, such as jogging.

Symptoms

Patients will often experience a clicking feeling in the forefoot followed by a sharp shooting pain or a sensation of numbness or pins and needles extending into ends of their toes. Tight narrow fitting shoes may often exacerbate these feelings which become worse after long periods of standing or walking. Once the Mortons nueroma progresses symptoms will become more frequent and often more intense.

Diagnosis

The most common condition misdiagnosed as Morton's neuroma is metatarsophalangeal (MTP) joint synovitis. When pain occurs in the third interspace, the clinician may misdiagnose the condition as Morton's neuroma instead of MTP synovitis, which may manifest very much like Morton's neuroma. MTP synovitis is distinguished from Morton's neuroma by subtle swelling around the joint, pain localized mainly within the joint, and pain with forced toe flexion. Palpation of the MTP joint is performed best with a pinching maneuver from the dorsal and plantar aspects of the joint to elicit tenderness of the joint. Other conditions often misdiagnosed as Morton's neuroma include the following. Stress fracture of the neck of the metatarsal. Rheumatoid arthritis and other systemic arthritic conditions. Hammertoe. Metatarsalgia (ie, plantar tenderness over the metatarsal head) Less common conditions that have overlapping symptoms with Morton's neuroma include the following. Neoplasms. Metatarsal head osteonecrosis. Freiburg. steochondrosis. Ganglion cysts. Intermetatarsal bursal fluid collections. True neuromas.

Non Surgical Treatment

Treatment for Morton?s neuroma will depend on how long you've had the condition and its severity. Simple non-surgical treatments are effective for some people. Others may need surgery. If Morton's neuroma is diagnosed early, treatment will aim to reduce the pressure on the affected nerve. This is usually the nerve between the third and fourth toe bones (metatarsals). Your GP or podiatrist (foot specialist) may recommend changing the type of shoes you usually wear, shoes with a wider toe area may help ease the pressure on the nerve in your foot. Using orthotic devices, such as a support for the arch of your foot to help relieve the pressure on the nerve. Anti-inflammatory painkillers or a course of steroid injections into the affected area of your foot may help ease the pain and inflammation. Alcohol and local anaesthetic is injected into your foot using ultrasound for guidance, studies have shown that this type of treatment is effective. Resting your foot and massaging your toes may also help to relieve the pain. You can make an ice pack by freezing a small bottle of water and rolling it over the affected area.interdigital neuroma

Surgical Treatment

When early treatments fail and the neuroma progresses past the threshold for such options, podiatric surgery may become necessary. The procedure, which removes the inflamed and enlarged nerve, can usually be conducted on an outpatient basis, with a recovery time that is often just a few weeks. Your podiatric physician will thoroughly describe the surgical procedures to be used and the results you can expect. Any pain following surgery is easily managed with medications prescribed by your podiatrist.

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