14/09/2022
Plantar digital Neuroma: General Surg/Conser
Morton’s neuralgia
Morton's neuralgia is a painful nerve disease of the foot due to chronic compression, which is caused by swelling and nodular thickening of the interdigital nerves (neuroma) mainly in the area of the metatarsal heads III and IV, more rarely between II and III.
Additional compression can also be generated by an inflammatory altered and enlarged bursa, which is also located between the heads of the metatarsals and can form a conglomerate with the nerve node.
Other foot deformities such as splayfoot and hallux valgus, which can also be caused by wearing unsuitable shoes that are too tight, are particularly conducive to the development of Morton's neuroma.
Symptoms are severe pain in the area of the metatarsus heads up to the toes especially after longer walking distances due to the rolling of the foot and can be detected by the compression of the Metatarsal heads, the “squeeze test”, which is very painful in Morton´s neuralgia.
At the same time, there is usually numbness of the toes in the shoe, requiring patients to remove their shoes and massage their feet. These intermittent paraesthesia and pain in the forefoot are caused by sclerosing thickening of the nerves digitales plantares communes.
Conservative treatment may consist of padding and spreading the anterior transverse arch, also with orthosis, to widen the spaces between and straighten the toes and thereby relieve the neuroma. Also, temporary pain management with local anaesthesia or infiltration of a local anaesthetic may be performed.
Surgical removal of the neuroma may be necessary.
References:
Fleischner, Dr. Gerhard, Der schmerzende Fuß, Monographie, Ein Kompendium der medizinischen Fußpflege Band II, Verlag Neuer Merkur München, ISBN 3-921280-745, 1991 (The aching foot, monograph, A Compendium of Medical Foot Care Volume II)
Grünewald, Klaus, et al GmbH, ISBN 978-3-95409-027-3, 3. Auflage 2015 und ISBN 3-929360-52-7, 1. Auflage 2001 (Theory of medical foot care, Volume 2, Picture Orthosis)
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