What is Morton Neuroma?
Morton Neuroma is a disorder involving the common plantar digital nerves that is produced by entrapment of the enlarged nerve and repetitive traction beneath the deep transverse metatarsal ligament, resulting in epineural and perineural fibrous overgrowth. In layman’s words, it is the swelling and inflammation of the nerve.
Most commonly, a benign neuroma or perineural neuroma affects the intermetatarsal plantar nerve of the second and third intermetatarsal spaces, resulting in nerve entrapment.
CAUSE OF MORTON NEUROMA:
- Foot and ankle biomechanics such as calf tightness, planovalgus, or varus abnormalities all contribute to foot overloading.
- It is more common in women and people with flat feet. Flat feet can put pressure on the nerve and produce inflammation.
- Morton neuroma is more common in women than in men because women frequently wear tight-fitting shoes and high heels.
- Medical issues such as hammertoes, bunions, and so on.
CLINICAL PRESENTATION OF PATIENTS:
- Foot pain when bearing weight towards the front of the foot (plantar web space). Pain is most common between the third and fourth toes.
- The nature of the pain varies greatly between individuals. Some persons have shooting pains in the contiguous portions of two toes. Others report the sensation as though they had a rock in their shoe or are walking on razor blades.
- Burning, numbness, and paresthesia may also occur.
- Swelling and stiffness are two more symptoms.
The symptoms can be replicated by applying direct pressure between the metatarsal heads. The symptoms worsen with time.
- Patient’s history.
- Aggravating and relieving factors.
- Web-spaced tenderness test
- Gait analysis.
- Footwear observation.
- Imaging such as- X-rays to assess the existence of arthritis and rule out stress fractures/reactions and localized bone lesions
MANAGEMENT OF MORTON NEUROMA:
- Rest and Cryotherapy.
- Soft tissue massage.
- Manual therapy (metatarsal and talocrural mobilization).
- Kinesio taping to offload the joint.
- Dry needling.
- Extracorporeal shockwave therapy.
- Strengthening exercises for the intrinsic and extrinsic foot and ankle muscles.
- Stretching of Calf muscles.
- Electrotherapy such as therapeutic ultrasound.
Corticosteroid injections and surgical excision are common treatments, however, they may not always provide total relief.
Ultrasound-guided sclerosing alcohol injections, radiofrequency ablation, and cryo-ablation are all options.
Orthotics and Corticosteroid Injections
Orthosis helps to splay the metatarsal bones and increase nerve space, relieving pressure and inflammation.
In some people, corticosteroid injections can reduce inflammation and aid to alleviate symptoms. However, in most cases, the inflammation and pain return after a few weeks or months, and corticosteroids can only be taken a few times because they can cause gradual degeneration of ligamentous and tendinous tissues.
If such interventions fail, patients are frequently offered neurectomy surgery, which includes removing the damaged nerve tissue. Postoperative scar tissue formation (known as stump neuroma) can occur in 20%-30% of instances, resulting in the recurrence of neuroma symptoms.
Cryogenic neuroablation, commonly known as cryo injection therapy, is an alternative to neurotomy surgery. This term refers to the destruction of axons in order to prevent them from conveying unpleasant impulses. This is performed by making a small incision and introducing a cryoneedle into the neuroma, which applies extremely low temperatures to it.