Morton’s neuroma (foot): treatment, symptoms, removal
Morton’s neuroma is called thickening of the plantar digital nerve, which causes severe pain and limitation of walking. In Oncology is called a neuroma tumor of the nerve, emerging from its elements, but in this case the tumor is not formed, and the name of the pathology historically because of characteristic symptoms and whether the patient’s palpable education on the nervous trunk. From this point of view, it is better to call a neuroma metatarsalgia, indicating the presence of pain in the metatarsal.
When Morton’s neuroma affects one of the plantar nerves providing the innervation of the fingers. Education is from the point of division into branches, going to the toes, near the heads of the metatarsal bones, passing which, the nerve is compressed by the transverse ligament of the foot.
Among patients with metatarsalgia dominated by women at a young age, usually show a unilateral lesion in the third space between the fingers, less frequently in others. In this place there is pain and detectable seal. Here the nerve divides into branches going to the lateral surfaces of the fingers, so the pain spreads and in there.
Not threatening the patient’s life, neuroma of Morton, however, can deliver serious discomfort, limiting the active life and movement, and in some cases, the disease leads the patient to the surgeon, so timely diagnosis and treatment are of paramount importance.
Causes of Morton’s neuroma
Joints the shank are connected by a transverse ligament, which are common interdigital nerves divisible by finger, going to the sides nearby the toes in such a way that each nerve participates in the innervation of the facing each other surfaces of the fingers. The heads of the metatarsal bones are located close to each other, and the nerve passes in a narrow space bounded by bones and ligament.
Feet experience enormous stress during the process of walking or standing on my feet, so very susceptible to various kinds of violations, not only from the joint and ligaments, but nerves, blood vessels. Passing in the ligaments between tightly spaced bones and joints, nerves stop often strangled and strangulated, causing them damage and pain. This is especially true when the existing foot pathology – deformation, fracture, age-related changes.
The main cause neuromas consider excessive load on the foot, which occurs when:
- Wearing uncomfortable, tight shoes, as well as the fascination with high heels;
- Excess weight, which creates tension across the foot;
- Improper gait and posture;
- A long stay in a standing position, walk long;
- The employment in certain types of activities, with emphasis on the foot.
The risk group includes people with flat feet and deformity of foot or toes, arthritis, a person with a history of trauma with injury of a nerve or compression by a hematoma. Disadvantage consider inflammation of joint elements (bursitis, tendonitis), as well as other tumors that compress the nerve from outside.
In the presence of the above conditions, nerve prejudiced, but in response to this swelling occurs, the expansion of its sheath, connective-tissue structures with the formation area of the seal, which is even harder to fit in the limited space between the ligaments of the foot, and then there is pain. Neuroma Morton’s has the appearance of spindle-shaped tumor, which is based on connective tissue. Because the elements of education do not show signs of autonomy or atypia, and represent a reactive process, the number of neoplasias such a neuroma will not carry.
The manifestation of Morton’s neuroma
Symptoms boil down to:
In the beginning of the formation of neuroma of the foot may not be palpable, but the pain was already worried patient. Itís clear relationship with the wearing of tight shoes after the patient noted considerable relief. Pain can pass at all, but after a while comes back again.
The disease at first is of a recurrent nature, and at this stage the doctor will not everyone, because the symptoms decrease or disappear. In advanced cases the pain becomes constant and quite intense, similar to the sensations that arise while walking on sharp stones, and worried about even when the feet are shod with Slippers, and the patient sits or lies. The more time passed from the onset of the disease, the more intense the pain. The inability to stop it available means results in this phase on reception to the expert.
Pain is usually concentrated in the third interdigital space, during the second and third finger – this is where the neuroma is formed most often. In connection with compression of nerve fibers numbness, tingling. Often patients complain of a feeling of presence of a foreign body in the Shoe.
A small neuroma of the foot is not palpable, but palpation of the deep gives you a strong attack of pain. With increasing tumor formation on the nerve it can be felt in the tight restricted area in the projection of the branches of the plantar nerve. A characteristic feature is the localized pain between the metatarsal bones, while in other diseases it occurs in their heads. This feature is important for the differential diagnosis of metatarsalgia.
The identification of Morton neuroma is possible even at the initial stage on the basis of characteristic clinical manifestations, but at this point, patients prefer to be treated at home yourself. When the pain becomes unbearable, the patient comes to the doctor – podiatrist, neurologist, surgeon, orthopedist. Podiatry – specialist, focusing exclusively on problems of the foot.
After hearing complaints, it is already possible to put the correct diagnosis and to confirm the neuroma doctor suggests additional tests and surveys:
- Compression of the foot leads to increased pain and a marked spreading of the sides of the fingers, which I consider pathognomonic sign of the disease;
- Radiography and CT scan of the foot, though not allow you to «see» the neuroma, because it Magadana and not seen on x-rays but help in the diagnosis of flat feet, injury, changes in bone components of other tumors;
- MRI shows the presence of site seals, but in this case, the method is not very useful, possible diagnostic errors;
- Ultrasound examination is the most informative method of diagnosis of the neuroma, which, moreover, is harmless, cheap and has a minimum of contraindications.
How to deal with illness?
Treatment of Morton’s neuroma involves conservative measures surgery.First of all, you should change the shoes more comfortable, eliminating incorrect position of the feet.
Useful orthotics or tab. Because the foot is all different, for best effect it is advisable to make these insoles individually, taking into account the specific configuration of the foot of the patient.
Amateur high-heel or, on the contrary, now so fashionable ballet flat shoes, needs to think about if not about the change of shoes, at least about restriction of time of stay in it. The best is the heel about a half to two inches. At this altitude, the foot is a physiological condition and able to take on a greater burden body weight. Should avoid prolonged standing or walking, which exacerbate the pain.
Treatment at home – usually, the first thing that make people with pain in the foot. Accessible and useful warm foot bath, massage, allowing you to remove muscle tension. Folk medicine advises to use a hot compress with pork fat, sage. These methods help to reduce pain and facilitate walking, but the disease is not cure, so sooner or later the patient will still have to go to the doctor.
The fascination with folk remedies should remember that all packs and ointment is contraindicated in skin diseases, inflammatory or pustular lesions of the skin of the feet, so even adherents of alternative medicine must first consult with specialists clinic.
Treatment of a neuroma does neurologist, orthopedist, traumatologist or surgeon. Generally, patients with symptoms of this education are turning to a surgeon in his clinic, who advises conservative treatment and observation, or by active surgical tactics.
Cupping pain is a wide range of anti-inflammatory and analgesics, which can be used internally in the form of tablets or powder, and topically in the form of ointments, gels or cream. Help diclofenac, nimesulide, ibuprofen, Ketoprofen, but before to use them inside, you need to read the instructions, as many NSAIDs are contraindicated in the pathology of the stomach and intestines (ulcer, gastritis).
When expressed pain syndrome, which can not be removed with conservative methods, the doctor can appoint carrying out the blockade with an anesthetic (lidocaine) in the area of the affected nerve.
When Morton’s neuroma is widely used physiotherapeutic technique – magnetic therapy, electrophoresis of drugs, acupuncture.
If the ways of dealing with a neuroma does not bring results, then the question about the need for surgical intervention. It is less traumatic, performed on an outpatient basis and requires General anesthesia. After a short procedure, the patient can immediately go home. Surgical treatment is considered the main, as conservative methods do not give a lasting effect and their effect is short-lived.
Surgery for Morton’s neuroma is to cut the transverse milusheva (release) – is a gentle method of treatment, either in removing the neuroma. The tearing of the ligament takes about ten minutes, and after 1-2 hours the patient leaves the surgeon’s office. It is possible to get home will need additional support, but in most cases walking after surgery does not cause discomfort and pain. The tearing of the ligaments – the first stage of treatment, is not accompanied by removal of the portion of nerve and numbness, so it is preferable.
The tearing of the ligaments is not a radical operation, so to eliminate the likelihood of recurrence impossible. With the resumption of the pain and the progression of the disease shows different treatment is the complete removal of the neuroma. The operation is performed in a clinic under local anesthesia, but requires more time than the tearing of the transverse ligament of the shank.
During the intervention the surgeon makes a skin incision with a length of about two centimeters in the projection of the heads of metatarsus, excised thickening of the nerve and sutured the soft tissues, completely eliminating the pathological process. Immobilization of the foot is not required, and the patient after treatment goes home. Some time you may feel numbness in the interdigital space, but the walk is not affected and passes quickly.
Following the surgery 10-12 days the patient is home, he is given sick leave, 12 to 14 days the stitches are removed. During this period you need to limit the load on the foot, and if necessary walk – to put on comfortable and loose shoes. In the touch to the fingertips in the postoperative period can detect that they are numb. This is a consequence of the removal of the portion of the nerve. When walking and in the absence of touch of the skin numbness is not felt and does not interfere with normal life, therefore, should not worry the patient. The recovery period takes about a month, but after 2 weeks you can return to normal activities.
If the labor activity is associated with a prolonged stay in a standing position, walking, physical exertion, the issue of temporary restriction thereof to the end of the rehabilitation period.
There is another type of operation which, however, is used very rarely due to the long period of rehabilitation. This method produces a fracture of the fourth metatarsal bone (osteotomy) and the subsequent displacement of its head with the release of the nerve from pressure. The surgery requires no incisions, carried through the puncture under the control of the x-ray machine. Advantages of the technique consider the lack of scars, but the need for long-term recovery does not allow the procedure to many patients. Rehabilitation requires the additional month required for fusion of the metatarsal bone.
A Morton’s neuroma can be prevented, and this is to follow some preventive guidelines. So, the first thing to pay attention to the choice of shoes, comfort and correct size. If a woman can not give up the heel, you can try to limit the time spent in such shoes, and in the evening are shown relaxing baths and foot massage.
With flat feet the risk of neuroma increases, so the impaired children forming the arch of the foot it is necessary to wear special insoles. Adults with deformities of the fingers or joints of the foot also needs insoles, inserts, tabs, fingers, useful for orthopedic shoes.
All, without exception, regardless of healthy feet, we need to observe the correct motor mode, not involving prolonged standing or too much walking, when the load on the foot maximum. If, however, the signs of neuroma appeared, then a timely visit to the doctor will help to heal it conservatively. Sometimes the insole or change shoes eliminate symptoms and self-treatment only aggravates the disease and inevitably leads to the need for surgery.