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Morton’s neuroma

Definition

This can generally be described as an irritation and/or swelling of the sensory nerve that branches near the heads of the metatarsal bones. Each time, a nerve branch goes to the outside of the innermost toe, and the inside of the most exterior toe.

Such neuroma is most common at the height of the third intermetatarsal web space (this is the space between two metatarsal bones) and to a lesser extent at the level of the second web space. It is mainly seen in women, not necessarily on both feet.

Symptoms

Usually people complain of a kind of electrical discharge or a shooting pain between two toes. However, this pain is almost exclusively observed while wearing shoes, during walking, or while standing upright for a long time in the same place.,…
Especially when wearing tight shoes, one should stop walking, remove the shoes and move the toes a little bit, and perhaps put the foot on a cold surface. Some patients have a radiating pain in the back of the metatarsal. Also tingling in the toes, which are innervated by the concerned nerve, can be experienced.

Causes

Since the irritation of the nerve leads to inflammation and/or swelling, one has to deal with the causes during the treatment. This irritation can be due to external mechanical factors such as bursitis, metatarsal arthritis, necrosis or swelling, metatarsalgia by mechanical overpressure. Sometimes, the formation of a neuroma is less clear.

After a clinical suspicion, one must always request a simple standing radiograph and an ultrasound. If there is still doubt after that, a magnetic resonance can confirm the diagnosis.

Treatment

The treatment is mainly non-surgical. Wearing shoes with a wide tip and a heel not higher than 4 cm, if necessary together with wearing orthotics with a retro capitale support, should be considered as initial treatment. The injection of some cortisone, to be repeated several times, is another possibility.

In case of surgery, the neuroma gets removed, which postoperatively can lead to a hollow feeling in the region that was previously innervated by that nerve. Another consequence of removing that sensory nerve is the development of a new neuroma, which sometimes makes the preoperative symptoms recur.

Postoperative policy

After the operation, one can lean as soon as the pain permits.