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Mortons Neuroma Causes

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MortonMorton's neuroma (also known as Morton neuroma, Morton's metatarsalgia, Morton's neuralgia, plantar neuroma, intermetatarsal neuroma, and interdigital neuroma) is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the second and third intermetatarsal spaces (between 2nd-3rd and 3rd-4th metatarsal heads), which results in the entrapment of the affected nerve. The main symptoms are pain and/or numbness, sometimes relieved by removing footwear.

Causes

In many cases, a neuroma may develop as a result of excessive loading on the front of the foot. Sometimes, a patient?s anatomic alignment in the forefoot contributes to the overload. There may be some cases where the neuroma develops spontaneously, for no obvious reason. However, once the nerve is irritated, pressure from walking, and from the adjacent bony prominences (metatarsal heads), as well as from the intermetatarsal ligament that binds the heads together, all may contribute to persistent pain. Repetitive pressure on the nerve causes localized injury with resulting scarring and fibrosis of the nerve. This leads to symptoms in the distribution of the nerve.

Symptoms

Symptoms include tingling in the space between the third and fourth toes, toe cramping, a sharp, shooting, or burning pain in the ball of the foot and sometimes toes, pain that increases when wearing shoes or pressing on the area, pain that gets worse over time. In rare cases, nerve pain occurs in the space between the second and third toes. This is not a common form of Morton neuroma, but treatment is similar.

Diagnosis

A doctor can usually identify Morton's neuroma during a physical exam. He or she will squeeze or press on the bottom of your foot or squeeze your toes together to see if it hurts. Your doctor may also order an X-ray of your foot to make sure nothing else is causing the pain.

Non Surgical Treatment

The first line of treatment is to try modifying footwear. Often simply wearing broader fitting shoes can reduce pressure on the neuroma and so reduce pain. Orthotic inserts can also help as they can again help reduce pressure on certain parts of the foot. Padding and taping the toe area is another option. In some cases a steroid injection into the foot may be suggested. This can be done as a day case without the need for anaesthesia and helps reduce inflation of the nerve. It can halt the pain in round 70 % of cases. Sometimes a combination of alcohol and local anaesthesia may be injected as this helps reduce pain.Morton neuroma

Surgical Treatment

If symptoms do not respond to any of the above measures then surgery may be suggested. This involves a short 30 minute operation to either remove tissue to take pressure off the nerve or to remove the nerve causing the pain. The surgery can be done as a day case but it will be two or three weeks before you can be fully active on your feet. There may be some lingering numbness afterwards if the nerve is removed. But surgery is successful in around 80% of cases. There is a small risk of complications such as infection and thickening of the skin on the soles of the feet.

Prevention

It is not always possible to prevent a Morton's neuroma. However, you probably can reduce your risk by wearing comfortable shoes that have low heels, plenty of toe space and good arch support.

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