31
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Mortons Neuroma Cure
31.05.2017 12:57
Overview

plantar neuromaDuring certain activities, particularly weight-bearing activities (e.g. walking or running) a compressive force, is sometimes placed on the interdigital nerves and surrounding soft tissue, between the metatarsal bones (this is often the case with tight fitting shoes or in patients with flat feet). If this force is repetitive enough and beyond what the nerve and soft tissue can withstand, swelling to the nerve and soft tissue may occur. This may result in pain, tenderness, pins and needles or numbness in the forefoot or toes. When this happens, the condition is known as a Morton's neuroma.

Causes

Various factors have been implicated in the precipitation of Morton's neuroma. Morton's neuroma is known to develop as a result of chronic nerve stress and irritation, particularly with excessive toe dorsiflexion. Poorly fitting and constricting shoes (ie, small toe box) or shoes with heel lifts often contribute to Morton's neuroma. Women who wear high-heeled shoes for a number of years or men who are required to wear constrictive shoe gear are at risk. A biomechanical theory of causation involves the mechanics of the foot and ankle. For instance, individuals with tight gastrocnemius-soleus muscles or who excessively pronate the foot may compensate by dorsiflexion of the metatarsals subsequently irritating of the interdigital nerve. Certain activities carry increased risk of excessive toe dorsiflexion, such as prolonged walking, running, squatting, and demi-pointe position in ballet.

Symptoms

The most common presenting complaints include pain and dysesthesias in the forefoot and corresponding toes adjacent to the neuroma. Pain is described as sharp and burning, and it may be associated with cramping. Numbness often is observed in the toes adjacent to the neuroma and seems to occur along with episodes of pain. Pain typically is intermittent, as episodes often occur for minutes to hours at a time and have long intervals (ie, weeks to months) between a single or small group of multiple attacks. Some patients describe the sensation as "walking on a marble." Massage of the affected area offers significant relief. Narrow tight high-heeled shoes aggravate the symptoms. Night pain is reported but is rare.

Diagnosis

The diagnosis of a Morton's neuroma can usually be made by the doctor when the history of pain suggests it and the examination elicits the symptoms. The foot is generally tender when the involved area is compressed and symptoms of pain and sometimes tingling can be elicited when the sides of the foot are squeezed. Magnetic resonance imaging (MRI) or ultrasound testing can be used to confirm the diagnosis if necessary.

Non Surgical Treatment

Treaments may include wearing wider shoes to reduce the squeezing force on the foot. Adding a specially made padding to shoes to offload the pressure on the ball of the foot (called a metatarsal dome) Addressing the foot and lower limb biomechanics. This involves looking at foot stability and if needed prescribing an orthotic device to correct your foot position. Anesthetic & Cortisone injections. This is done when the above treatments are insufficient. The trauma is sometimes so great that conservative treatment cannot control the inflammation or cause of the pain. A series of injections are performed to control the inflammation or to temporarily settle the nerve. An ultrasound and cortisone injection can be prescribed by your podiatrist.Morton

Surgical Treatment

When medications or other treatments do not work, podiatric surgery may be required. The most common surgical procedure for treating Morton?s neuroma is a neurectomy, in which part of the nerve tissue is removed. Although this procedure effectively removes the original neuroma, sometimes scar tissue known as a stump neuroma forms at the site of the incision. This may result in tingling, numbness, or pain following surgery. Surgery is effective in relieving or reducing symptoms for Morton?s neuroma patients in about 75% to 85% of all cases. Occasionally, minimally invasive radio frequency ablation is also used to treat Morton's neuroma.

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