Morton's neuroma: what is it, causes of the disease, how to treat?

There are many diseases that can cause pain and sensory disturbances in the foot. One of them, although not the most common, is Morton's neuroma. Many people suffering from this pathology say that they live with constant pain and walk “as if on sharp stones.” This is due to the growth of the nerve sheath and the false hope that everything will go away on its own. Unfortunately, this does not happen, and orthopedists, neurologists and therapists are often forced to deal with advanced cases of Morton's neuroma. Although it is possible to solve a problem that has been poisoning the lives of many people for years and does not allow them to enjoy active recreation and even walks in just 15-60 minutes.

What is Morton's neuroma

The foot is built in such a way that a thin metatarsal bone leads to each toe; their heads, together with the phalanges of the toes, form the metatarsophalangeal joints. In the immediate vicinity of the metatarsal bones, intermetatarsal nerves pass, branching into 2 branches in the area of ​​the interdigital space. Each of these branches is responsible for transmitting nerve impulses to the lateral surfaces of neighboring fingers. In the area of ​​the metatarsal heads, the interdigital ligament passes, touching the intermetatarsal nerves.

Morton's neuroma is a thickening of the intermetatarsal nerve sheath at the site of its division into 2 branches innervating two adjacent toes. Since it is located in close proximity to the heads of the metatarsal bones and the transverse ligament of the foot, these structures are capable of compressing the thickened nerve during walking and other types of physical activity, which leads to pain of varying degrees of intensity.

But the name of the disease does not accurately reflect its nature and essence. The concept of neuroma is widely used in oncology to describe tumors of the nerves, but in this case we are not talking about the formation of a tumor, and therefore the pathology has nothing to do with malignant processes. Since the formation of Morton's neuroma is accompanied by the formation of a thickening of the nerve, which can even be felt upon palpation, historically it came to be called a neuroma. The name has taken root in medicine, although it would be more correct to call this pathology Morton’s metatarsalgia.

Morton's neuroma is also called perineural fibrosis, intermetatarsal neuroma, plantar neuroma.

Morton's neuroma is one of the diseases accompanied by the development of carpal tunnel syndrome. In essence, it is a benign thickening of the nerve, formed as a result of thickening of its sheath and the formation of a connective tissue sheath around it. It was found that its dimensions can be 0.15-0.65 cm in width and 0.95-1.45 cm in length, i.e. the thickening has an elongated, spindle-shaped shape.

Most often, young women suffer from this pathology, and damage to the nerve trunk of only one of the feet is usually observed, although the development of a bilateral process is also possible. In most cases, the thickening is located between the 3rd and 4th toes, where the painful lump occurs. Somewhat less frequently, it forms in the 2nd interdigital space and very rarely in the 1st and 4th, i.e., at the big toe and little toe. Since the branches extending from the affected nerve innervate the lateral surfaces of the corresponding fingers, pain when irritated by the thickening tends to radiate to them.

Interestingly, Morton's neuroma almost never occurs in children. Their similar symptoms are usually caused by metatarsal fractures or metatarsophalangeal joint dislocations.

Thus, Morton's neuroma does not pose a threat to life, but can significantly reduce its quality, making it difficult to lead an active lifestyle and perform everyday tasks due to severe pain in the feet and fingers. Due to the resulting limitations in mobility, patients experience serious physical and psychological discomfort, which should not be tolerated. The possibilities of modern medicine make it possible to get rid of constant pain in the foot and restore the patient’s joy of life and movement.

Reasons for development

American surgeon Thomas George Morton in 1876 described a syndrome that he observed in 12 patients with unusual foot pain in the area of ​​the 3rd interdigital space. He suggested that this is a consequence of mechanical compression of the nerve by the heads of the metatarsal bones. But today it is believed that in fact the disease is of a polyetiological nature.

The exact mechanism of formation of Morton's neuroma is not yet known, although various studies have been carried out in this direction, thanks to which a substantial amount of knowledge has been accumulated. As a result, there were suggestions that thickening of the nerve most likely becomes a consequence of constant overload of the forefoot, frequent repeated microtraumas, long-term, constantly repeated compression, i.e. squeezing, of the foot and, accordingly, the nerve. There is also evidence that nerve thickening can form as a result of ischemic phenomena, i.e., nutritional disorders, which can be observed when the walls of the blood vessels supplying a given area of ​​the foot thicken or their lumen is completely blocked.

Therefore, today it is believed that nerve compression and constant microtrauma lead to a gradual thickening of the transverse intermetatarsal ligament of the foot with its disintegration and the development of edema. The formed pathological intermetatarsal ligament causes constant compression and displacement of the medial plantar nerve and the vessels that supply it, which provokes the occurrence of ischemic phenomena and compensatory thickening of the plantar nerve sheath.

Additional factors contributing to the development of the disease may be damage to bones and soft tissues, as well as the development of the inflammatory process, which is accompanied by the formation of an infiltrate. All this can lead to the nerve becoming firmly fused with the surrounding tissues, its sheath thickening to protect the delicate structure from damage, resulting in the formation of a space-occupying lesion. Since the distance from the intermetatarsal nerve to the metatarsal bones and interdigital ligament is extremely small, these anatomical structures compress the overgrown nerve sheath, i.e., its compression occurs, which causes the occurrence of tunnel syndrome with all its manifestations.

It is believed that genetic predisposition also plays a role in the occurrence of Morton's neuroma. Although the action of external and internal factors is still given leading importance.

Thus, the main reasons for the development of the disease are:

• transverse flatfoot and/or development of valgus deformity of 1 toe (Hallux Valgus);
• wearing shoes that are too tight, in particular narrow shoes with high heels, which explains the fact that the pathology is 4 times more common in women;
• injuries and formation of hematomas at the site of the nerves of the foot;
• gait disturbances with the foot turning inward, which leads to excessive tension on the nerve;
• vascular pathologies of the lower extremities, accompanied by fusion or closure of their lumen and acute circulatory disorders, i.e. obliteration (obliterating atherosclerosis, endarteritis of the lower extremities);
• obesity, leading to increased stress on the legs and feet in particular;
• increased loads on the forefoot;
• inflammatory diseases of the joints and ligaments of the feet (bursitis, tendovaginitis);
• some infectious and autoimmune diseases;
• lipomas of various types in the metatarsal area;
• changes in nerve anatomy.

Very often, Morton's neuroma occurs in women who constantly wear tight high-heeled shoes, as well as in people who actively engage in sports or are forced to stand for long periods of time. Excess weight and heavy physical labor or overly active sports are the main causes of pathology in men.

Pregnancy can act as a trigger for the rapid development of the disease. This is due to the relatively rapid increase in a woman’s body weight, which leads to an increase in the load on the foot. Therefore, it is extremely important from the first days of pregnancy to wear comfortable, non-squeezing shoes and avoid too much stress.

Thus, the risk group for developing Morton's neuroma includes:

• women who constantly wear narrow high-heeled shoes;
• people who are forced to stand or walk for a long time due to the nature of their profession (salespeople, teachers, flight attendants, waiters);
• people engaged in heavy physical labor (loaders, professional athletes, especially figure skaters, speed skaters, track and field athletes);
• patients with any diseases and deformities of the feet, especially flat feet, bursitis, arthrosis, tendinitis, tumors, hallux valgus.

Competencies

Morton's neuroma

• Reasons for development
• How the disease develops
• Symptoms
• Diagnostics
• Consequences of the disease
• Treatment

Morton's neuroma is a pathology that is characterized by the appearance of a fibrous formation on the foot in the area of ​​the plantar nerve. The disease has other names: Morton's finger syndrome, interdigital neuroma, perineural syndrome. They are all synonyms. Neuroma occurs in both women and men. However, women still get sick more often, especially in mature and old age - after 45–50 years.

Reasons for the development of the disease

The risk of developing Morton's toe syndrome is caused by several factors that negatively affect the tissues of the foot.

These include:

• Traumatic injuries of the foot, accompanied by compression of nerve formations in the interosseous space;
• Transverse flatfoot, which deforms the foot and disrupts its normal innervation;
• Hematomas (soft tissue bruises) pressing on the nerve;
• Chronic infections affecting the tissues of the foot;
• Obliterating diseases of the legs that interfere with blood supply;
• Prolonged physical activity with the patient constantly in a standing position (for example, at work);
• Obesity, which gradually leads to foot deformation and compression of the plantar nerve.

Also, the shoes worn by the patient play a big role in the development of Morton's neuroma. You should not buy constricting, uncomfortable shoes and boots - this leads to disruption of the blood supply and innervation of the tissues of the foot.

As you can see, perineural fibrosis can be caused by many unrelated causes. Only an experienced surgeon can determine what exactly causes the disease and how to cure it.

How does Morton's neuroma develop?

Most often, Morton's neuroma develops in the space between the third and fourth toes - the third intermetatarsal space. The disease is usually unilateral. In rare cases, with rapid onset and early progression of perineural fibrosis, neuroma can form on both sides.

The main pathological factor in the development of the disease is excessive pressure exerted on the bones of the foot. The bones become deformed and change position, causing the plantar nerve to be compressed. An inflammatory process develops around the damaged tissues, which ends with the active growth of connective tissue in the area and its fusion with the bones and muscles of the foot. The fibers that make up the plantar nerve degenerate and form so-called growth flasks, as well as Perriconcito spirals. The normal innervation of the foot is disrupted.

Symptoms

Morton's neuroma is characterized by a specific set of symptoms:

• Pain.
  Aching, at first it occurs only after physical exertion or long walking, then the discomfort intensifies significantly, and the periods of absence of pain are reduced. The presence of night pain is not typical for Morton's disease. Most often, discomfort is localized between the 3rd and 4th toes, but sometimes it can spread to the entire foot.
• Itching and burning in the affected area.
  Symptoms are associated with disruption of the nerve innervation of the foot.
• Unpleasant sensations when wearing shoes.
  The patient feels discomfort, as if some object was shoved into his shoe that is not actually there.

Morton's disease is characterized by a slow onset. Over time, the signs of the disease intensify, and the disease increasingly interferes with the patient’s ability to walk normally. In severe cases, symptoms of the pathology can also occur at rest, when the patient does not move for a long time.

A characteristic sign of perineural fibrosis is the absence of foot deformities that are visible to the naked eye. The slightest displacement of the bones is enough to compress the nerve. In this case, outwardly the leg will look completely normal, changes are noticeable only at the microscopic level.

Diagnostics

A surgeon diagnoses Morton's neuroma. The patient’s complaints are of great importance - the patient needs to be told in as much detail and clearly about the symptoms as possible. The doctor also pays special attention to the medical history. The patient needs to remember when he felt the first signs of pathology, when they intensified, and how their severity changed over time. It is important to determine under what circumstances pain appears - during strong and prolonged physical activity or during small ones. This will help you understand how severely the plantar nerve is affected.

To clarify the diagnosis, the doctor conducts a local examination of the foot with palpation of its surface. When compressed, pain is clearly defined, localized in the area of ​​the third intermetatarsal space. The appearance of numbness of the fingers during palpation in this area also indicates the presence of Morton's neuroma in the patient. There should be no external changes on the foot; bone deformation indicates the presence of concomitant pathologies or an incorrect preliminary diagnosis.

Often, to exclude other diagnoses, the patient is prescribed an X-ray examination, in which all bone formations are clearly visible. If the doctor has doubts about the nature of the disease, he sends the patient for an MRI. This technique makes it possible to visualize the soft tissues of the foot.

To determine the exact location of perineural fibrosis, local anesthetics are injected into the affected area. If the pain suddenly disappears, then the pathological focus is identified correctly. Based on all the data obtained during the examination, the doctor makes an accurate clinical diagnosis and prescribes surgery to remove Morton's neuroma.

Consequences of the disease

With timely consultation with a doctor and proper treatment, the prognosis for the patient is favorable. But if the patient does not pay attention to the alarming symptoms or completely ignores them, Morton's disease will progress over time. Strong physical exertion will become unbearable for the patient, he will not be able to walk for a long time. You can also forget about playing sports. Such consequences can be avoided if you consult a doctor when the first symptoms appear. The doctor will select the right therapy and, if necessary, prescribe surgical treatment.

Treatment of Morton's neuroma

Treatment of Morton's finger syndrome can be either conservative or surgical. Only a large complex of therapeutic procedures will help the patient get rid of an unpleasant disease.

The extent of treatment depends on the severity of symptoms and the stage of the disease - the doctor determines how to treat Morton's neuroma, taking into account various factors.

Conservative treatment

In the early stages of Morton's neuroma, the patient usually does not require surgery. The syndrome can be cured with conservative therapy, the main goal of which is to reduce pressure on the arch of the foot and ease the load on the bone formations.

For mild cases of the disease, it will be enough to follow a number of rules:

• Choose comfortable, soft shoes that fit well and don’t squeeze your feet. Preferably with a flat sole;
• Buy special orthopedic insoles;
• Reduce the load on the foot - walk less, avoid prolonged standing;
• Do a foot massage daily.

By following these recommendations, a patient with a mild form of neuroma can quickly get rid of pain and discomfort in the legs.

To treat Morton's finger syndrome, analgesics that block pain are actively used:

• Nimesulide;
• Diclofenac;
• Solpadeine;
• Codelac.

Physiotherapeutic treatment is of great importance in conservative therapy. This may be electrophoresis of the affected area, the use of diatoks, laser, or electromagnetic radiation. During the rehabilitation period, after the exacerbation of Morton's disease has stopped, the patient is recommended to perform a special set of physical therapy exercises aimed at restoring normal activity of the limbs.

Unfortunately, conservative treatment for Morton's neuroma is not always effective. In most cases, surgery cannot be avoided.

Surgery

Surgical treatment is necessary when the pathology is in advanced stages and its conservative therapy does not produce results.

Doctors identify several ways to eliminate Morton's finger syndrome:

• The simplest method is ectomy (removal) of the neuroma. The surgeon makes an incision in the interdigital space, finds the affected nerve and removes the resulting formation. After this, he places interrupted sutures on the surface of the wound and removes them two weeks after the operation.
• The second method involves releasing (cutting) the transverse metatarsal ligament. This leads to the fact that the compression of the nerve disappears and the innervation is restored. At the same time, the integrity of the nerve itself is also preserved, which is very important in the treatment of the disease.
• Osteotomy is rarely used. During the operation, the bone is carefully sawed in a strictly defined place. This relieves compression of the plantar nerve. This method is also called an artificial fracture.

After removal of Morton's neuroma, a period of rehabilitation begins. During this time, the patient should limit all stress on the legs, wear only comfortable shoes without heels and avoid hypothermia of the foot.

In severe cases of pathology, radical surgery is required, in which the inflamed area of ​​the foot is simply excised. Such intervention is carried out very rarely, only if there are strict indications.

Many sites advise ways to treat Morton's neuroma using traditional medicine methods at home. Unfortunately, we have to admit that such treatment is ineffective. Various tinctures and ointments can eliminate symptoms and relieve pain, but the disease itself will not disappear and will steadily progress.

Without proper treatment, the prognosis for the patient is disappointing. You should not ignore the symptoms of the disease, otherwise you will have to deal with serious consequences. Morton's disease is a complex pathology with a constantly progressive course. Therefore, if symptoms appear, be sure to schedule a preventive examination with your doctor.

Symptoms of Morton's neuroma

While the neuroma is small in size, i.e., does not reach 5 mm, it usually does not manifest itself in any way and patients do not even suspect the presence of any problem in the foot. In such cases, pain or a feeling of tightness may appear when putting on uncomfortable shoes and quickly go away after they are removed. Sometimes there is discomfort between the toes after wearing such shoes or a slight tingling sensation.

However, provided that the action of the provoking factors continues, the thickening begins to increase in size, which first leads to the appearance of shooting and aching pain in the area of ​​the 3rd interdigital space. They usually occur after exercise and walking, and may also be accompanied by the development of various sensory disorders, including:

• crawling sensation;
• burning;
• tingling;
• pain of varying intensity arising from mechanical or thermal irritation.

Moreover, Morton's neuroma is characterized by an almost complete absence of any discomfort in the foot at night.

If at this stage of the development of the disease a person does not consult a doctor, and the cause of pain, paresthesia, allodynia and other sensitivity disorders is not established and, accordingly, treatment with lifestyle correction is not carried out, the symptoms of the disease continue to intensify. The frequency and severity of pain, which can become throbbing, gradually increases; the interval between the start of physical activity and the appearance of the first discomfort is observed to decrease. Often, pain syndrome forces a person to take off their shoes and massage the affected area of ​​the foot. This is due to the continued growth of the nerve thickening.

The disease can have a wave-like course, that is, with periods of intensification of symptoms and their temporary subsidence or even elimination. Sometimes manifestations of the disease may be absent even for several years.

In the later stages of pathology progression, when Morton's neuroma reaches large sizes, patients suffer from:

• sharp, burning pain that can occur even at rest and does not depend on the type of shoes the patient wears;
• sensations of the presence of a foreign object in shoes (as a rule, patients talk about the feeling of a pebble getting into their shoes);
• increasing intensity of sensitivity disorders up to its complete loss;
• changes in gait with forced lameness, since it is difficult to step on the affected leg, and the need to frequently stop while walking.

What is characteristic of this disease is the complete absence of external changes in the condition of the foot and the affected interdigital space. In this case, when you press on the area where the thickening of the nerve is formed, the pain increases sharply.

Severe pain syndrome that occurs during physical activity makes it impossible to engage in sports that involve stress on the legs, i.e. running, jumping, dancing, skiing, roller skating, skating, etc. Even normal walking becomes a challenge for people with this pathology .

Diagnostics

If signs of Morton's metatarsalgia develop, you should consult an orthopedist or neurologist. Diagnosis of the disease is not difficult, and in most cases the doctor can suspect the presence of this particular pathology only on the basis of data obtained during a survey and examination of the patient.

Finding out the characteristics of the shoes that a person is used to wearing, as well as the length of time he or she wears them every day, is of great diagnostic importance. The specialist will definitely inquire about the presence of chronic and autoimmune diseases, vascular disorders, past injuries, etc. During the examination, the doctor draws attention to the presence of excess weight, flat feet and the presence of pain when palpating the area between the 3rd and 4th fingers or others, depending on the where the discomfort is felt.

A special test can also be performed, which consists of pressing the 3rd intermetatarsal space for 30-60 seconds. The presence of Morton's neuroma is indicated by the occurrence of numbness and burning at this point, which can spread to the lateral surfaces of the 3rd and 4th fingers. Additionally, a positive Tinnel's sign can indicate the presence of Morton's neuroma, i.e., the occurrence of pain when tapping the metatarsal bones of the 3rd and 4th toes, as well as the appearance of severe pain when squeezing the forefoot and toes.

However, in order to confirm the benign nature of the disease and exclude a number of other pathologies that can be accompanied by similar symptoms, patients are prescribed instrumental research methods. Indeed, much more often than the development of metatarsalgia, pain in the foot is caused by various deformations, in particular flat feet, which can be one of the causes of Morton's neuroma, as well as chronic tendinitis of the Achilles tendon. Differentiation is also required with hereditary spastic paraplegia, synovitis, arthritis of the metatarsophalangeal joints, stress fractures, osteonecrosis of the metatarsal bones, and tumor formation.

Some pathologies of the spine may also be accompanied by pain and sensory disturbances in the foot, in particular intervertebral disc herniations in the lumbar region.

To diagnose Morton's neuroma, the following may be performed:

• MRI or magnetic resonance imaging is an effective method for diagnosing a huge number of different soft tissue diseases. But in the case of Morton's neuroma, it is not always able to provide comprehensive data to confirm or refute the diagnosis, and often gives questionable results.
• CT or computed tomography - allows you to obtain accurate information about the condition of bone structures, especially at the site of thickening of the nerve, the presence of flat feet, and the consequences of injuries.
• Ultrasound is one of the main methods for diagnosing the disease, as it allows you to accurately determine the area of ​​thickening of the intermetatarsal nerve, as well as detect degenerative-destructive changes in the joints.

The presence of Morton's neuroma can also be confirmed as the cause of the appearance of pain and sensitivity disorders of varying degrees of severity through a therapeutic and diagnostic blockade. This is the name given to the injection of a local anesthetic solution carried out in close proximity to the passage of the intermetatarsal nerve. A rapid reduction to complete extinction of pain is a convincing diagnostic criterion, indicating the development of Morton's metatarsalgia.

How to make an appointment with a doctor and surgery for Morton's neuroma?

First of all, to determine the size of Morton's neuroma, as well as to diagnose possible other diseases, foot specialists in Germany will need current MRI images of the foot and X-ray results. Once we receive all the necessary documents, within 1-2 business days we will email you information for patients, as well as a preliminary cost estimate for treatment of Morton's neuroma.

Foreign patients can make an appointment for Morton's neuroma surgery in a short time. We will be happy to assist in obtaining a visa after the advance payment indicated in the estimate has been received into our account. If a visa is not issued, the amount received is returned to you in full.

Due to sometimes long flights, we try to keep the time between the first examination and surgery to a minimum. During outpatient and inpatient treatment of Morton's neuroma, you will be able to use the services of qualified medical personnel who speak several foreign languages ​​(eg English, Russian, Spanish, Portuguese). Payment for a translator (for example, into Arabic) is carried out separately. We also organize transfers, we can book a hotel room, and we will tell you how to spend time in Germany for you and your relatives.

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Treatment of Morton's neuroma

For each patient, treatment tactics are developed individually, which largely depends on the stage of the disease, as well as the causes of its occurrence. In the initial stages of development, patients are usually recommended conservative therapy, which consists of:

• unloading the feet and abandoning tight shoes in favor of comfortable orthopedic ones with a small heel 2-4 cm high, ensuring proper distribution of the load on the foot;
• using metatarsal pads and lifts, which are special orthopedic inserts that are placed under the balls of the feet and fixed on the toes with elastic bands or silicone rings in order to separate the metatarsal bones and create an anatomically correct bend of the foot;
• wearing shoes with retrocapital support.

All these methods have one goal - reducing pressure on the affected nerve trunk. This will avoid further progression of the disease and reduce pain by reducing the load and compression of the intermetatarsal nerve.

In order to increase the effectiveness of the measures taken, patients are recommended to constantly wear orthopedic insoles specially made for them according to individual parameters. Thanks to this solution you will be able to:

• reduce the load on the forefoot and normalize the condition of the transverse arch, i.e., reduce flat feet;
• reduce the pressure of bones and ligaments on the modified nerve trunk;
• avoid the development or eliminate the inflammatory process in soft tissues, including those involving the nerve, which will make it possible to significantly reduce the intensity of pain;
• restore the anatomy of the foot, which will improve the gait and bring it closer to normal.

In the absence of severe pain, patients can be prescribed multicomponent compresses, which usually include NSAIDs, local anesthetics and dimexide, taking NSAID drugs orally in the form of tablets or capsules, or applying them directly to the interdigital space in the form of an ointment or gel. This helps to improve the condition, but does not have a pronounced therapeutic effect. In combination with compresses, muscle relaxants are usually prescribed, as well as manual therapy sessions, which can not only relieve muscle spasms and improve tissue nutrition by activating blood circulation, but also eliminate nerve compression by normalizing the position of the metatarsal bones and ligaments.

Additionally, you can massage your feet at home, as well as take relaxing baths with herbs.

Courses of physiotherapeutic procedures are also indicated. So, with Morton's neuroma, the following give a good effect:

• Magnetic therapy is a method that involves influencing the affected area with a pulsed magnetic field, which helps reduce inflammation, swelling and improve the course of metabolic processes in it;
• shock wave therapy (SWT) is a method of physical influence, through the use of which it is possible to improve blood circulation in the area of ​​​​the thickening of the intermetatarsal nerve and thereby reduce the severity of ischemia, as well as accelerate the elimination of inflammation and achieve pain reduction;
• electrophoresis with the introduction of anti-inflammatory and analgesic drugs - ensures rapid and deeper penetration of drugs into tissues, and therefore obtains a more pronounced therapeutic effect;
• acupuncture – involves irritation of biologically active points, which helps to activate recovery processes.

Light therapeutic exercises are often additionally prescribed, the implementation of which does not take much time, but allows you to activate blood circulation in the legs, increase joint mobility, and also strengthen and stretch the muscles of the feet. But you need to do exercise therapy every day without haste at a pace that is convenient for you.

The main exercises include the following:

• Sitting on a chair with your feet firmly planted on the floor, you need to pull your socks towards you as much as possible, and then pull them forward.
• Standing facing the wall and leaning against it with outstretched arms, you need to take one leg back about 30-50 cm. The remaining leg in front is rhythmically bent at the knee, making sure that both heels are pressed firmly to the floor.
• Sitting on the floor with straight legs stretched out in front of you, use a towel to pull your feet towards you with your hands.
• Sitting on a chair, they make small movements with their toes, tearing them off and placing them on the floor, imitating playing the piano.
• Sitting on a chair, place one leg with the ankle joint on the knee of the other and perform rotational movements alternately in both directions, trying to make as wide a rotation as possible.

If these measures are not enough or a more severe course of the disease is initially observed, patients are prescribed corticosteroid injections, which are performed in the intermetatarsal space on the dorsum of the foot. In 50% of cases, this measure is enough to significantly improve well-being. Such blockades reduce swelling and inflammation, which leads to a decrease in pain.

In cases where concomitant orthopedic pathologies, such as deforming arthrosis, are detected in patients, treatment appropriate to the situation is prescribed.

However, conservative therapy is not always effective. Therefore, if patients, despite the measures taken, are still bothered by pain and other symptoms of Morton’s neuroma, they are recommended to undergo surgical treatment of the pathology.

Conservative treatment of metatarsalgia

In many cases, metatarsalgia responds successfully to conservative treatment. Its nature directly depends on the type of disease diagnosed. Therefore, some patients may be prescribed complex drug therapy, others physical therapy and exercise therapy, and for others it will be enough to use orthopedic devices.

But conservative therapy will not be effective if patients do not eliminate repeated overloads of the forefoot. This is achieved by changing uncomfortable, tight shoes, in particular high heels, to more practical and correct ones from an orthopedic point of view. But many patients, especially women, are disgusted by the idea of ​​having to wear orthopedic shoes. This is due to the fact that in the perception of many people, shoes that are correct from an orthopedic point of view look rough and unattractive. In fact, today there are a lot of beautiful and neat models for different occasions that will prevent overload of the forefoot, and therefore the appearance of pain and the progression of existing disorders.

Orthopedic shoes have a moderately hard sole, a rounded, moderately wide toe, often a comfortable wide heel and a high heel that secures the foot well.

It is also important to normalize weight, which is especially important for obese patients. Because metatarsalgia interferes with the ability to significantly increase the level of physical activity, patients may be advised to seek help from a nutritionist. The doctor will draw up an optimal nutrition plan, explain the basic principles of selecting foods and their combinations, features of calculating portion sizes, etc. Moreover, such nutrition will be rational and balanced. It will provide the body with the substances it needs and will promote smooth weight loss. But any diet, especially mono-diets, is dangerous and only gives temporary results. Therefore, you should abandon them once and for all.

For metatarsalgia, the following may also be prescribed:

• Metatarsalgic inserts are special soft pads of a triangular, round shape, which are placed directly in front of the overloaded, painful area. They allow you to relieve it, and therefore reduce the severity of pain.
• Custom orthotics are an essential component of treatment for most orthopedic disorders. They are made separately for each patient, taking into account the degree of foot deformation and anatomical features. They ensure uniform distribution of the load on the supporting points of the foot, which leads to stopping the progression of pathological changes and eliminating pain.
• Finger inserts or splints are special orthopedic devices that are recommended for hammertoe deformity of the fingers. They help return the plantar plate of the metatarsophalangeal joints to their natural position.
• Hallux valgus splints and bandages are special fixators that help abduct the big toe to the anatomically correct position. Thanks to them, it is possible to stop further curvature of the metatarsal bone and big toe, and therefore the formation of a lump on the lateral surface of the foot.

If the patient is diagnosed with contracture of the calf muscles or some other diseases, it is definitely recommended to perform a set of exercise therapy exercises daily. They are aimed at stretching the lower leg muscles and training the foot muscles.

Taping can also be performed. The method allows you to redistribute the load and eliminate muscle tension.

Drug treatment is selected strictly individually, taking into account not only the nature of the detected changes, but also existing other chronic diseases. But from the very beginning of treatment, NSAIDs can be prescribed for immediate improvement in well-being in the form of products for internal or local use. They are used in short courses to relieve pain until the main therapy gives the expected result. For pathologies of the metatarsophalangeal joints, chondroprotectors can be prescribed. They are used in long courses and help improve the condition of the cartilaginous parts of the joints, which leads to a reduction in pain.

In some cases, for example, with Hallux valgus or Morton's neuroma, courses of physiotherapeutic procedures are resorted to. These may include:

• magnetic therapy;
• inductothermy;
• UVT;
• electrophoresis with the introduction of corticosteroids.

Surgery for Morton's neuroma

The current level of development of orthopedics allows for effective and rapid treatment of Morton's neuroma at any stage of development. Today there are several techniques used for this purpose.

Often the thickening of the nerve trunk is removed, which is performed under local anesthesia. The surgeon individually chooses the type of access to the nerve: from the back or plantar side of the foot. He then makes a soft tissue incision to visualize the nerve and resects the thickened part. After this, the tissues are sutured and covered with a sterile bandage.

This operation lasts no more than an hour and involves the removal of a modified section of the nerve. This leads to a rapid improvement in the condition and complete disappearance of the pain syndrome with no risk of relapse of the disease, i.e. its re-development. But the method has a drawback - loss of sensitivity in the area of ​​the foot for which the nerve was responsible for innervation.

The lack of sensitivity in such a small area does not in any way affect the supporting and motor function of the foot. It does not affect the patient’s condition and appears only when intentionally touching the area that has lost sensitivity. After such an operation, the recovery stage takes 2-4 weeks, during which it is recommended to reduce the load on the operated foot. You can get up and walk within a couple of hours after the operation, but you should limit the load on the forefoot, which is achieved through the use of special shoes with hard soles. The stitches are removed 2 weeks after the procedure.

However, loss of sensation even in a small area of ​​the foot seems to many surgeons to be too high a price to pay for treating Morton's neuroma, especially as a primary measure. In such situations, such surgical intervention is considered as a last resort, which should be resorted to only in the absence of the expected effect from other measures. Therefore, they often initially try to cope with the problem and eliminate pain using less radical methods, for example, by cutting the transverse ligament between the metatarsal bones. The operation does not require special preparation and lasts only a few minutes. Dissection of the ligament will eliminate compression of the nerve trunk without compromising its integrity, and therefore preserve sensitivity. If the operation does not give the desired result, you should think about removing the neuroma by excision.

Also, to treat the disease, a surgical treatment technique such as osteotomy of the 4th metatarsal bone can be used. But today it is practically not used. The essence of this type of operation is to create space for the thickened nerve, which will allow it to be decompressed. This is achieved by performing an artificial fracture of the 4th metatarsal bone and displacing its head. Osteotomy and further manipulations are carried out under X-ray control through a minor soft tissue incision or even a puncture with a diameter of about 2 mm. In this case, the foot must be fixed with a plaster cast, and the recovery period increases to 1 month.

Recently, Morton's neuroma is increasingly removed by laser or radiofrequency ablation. The essence of both methods is approximately the same and consists in introducing, under local anesthesia, a thin cannula directly to the site of localization of the nerve thickening, through which a laser or radio wave probe is then immersed. Due to the receipt of thermal energy, the modified section of the nerve trunk is destroyed, which leads to the elimination of the pain syndrome, but also provokes a loss of sensitivity on the adjacent lateral surfaces of the 3rd and 4th fingers. Thus, laser and radio wave treatment of Morton's neuroma allows one to obtain the same effect as open surgery, but is not associated with the formation of scars on the skin, since the puncture size is only a few millimeters, is less traumatic and is easier to tolerate by patients. The duration of the operation is about 30 minutes.

Modern operations performed for Morton's neuroma allow patients to feel better in more than 90% of cases. Moreover, in 45% of cases there is a complete elimination of pain and neurological symptoms, in 32% there is a significant reduction in them. Only in 15% of cases the result was satisfactory, i.e., there was a decrease in pain and preservation of neurological disorders, and in only 8% of patients who underwent surgery, the situation did not change for the better. Negative results are usually due to the formation of a true amputation neuroma of the intermetatarsal nerve.

Surgical treatment

Surgical treatment of Morton's neuroma should be considered only after unsuccessful non-surgical treatment and only if there is complete confidence that the symptoms are not initially associated with any other pathology, such as synovitis of the metatarsophalangeal joint, etc. Standard surgical treatment involves isolating the nerve and cutting it (resection) above the site irritation/injury. This is usually done through an incision on the top (dorsal) side of the foot, although an incision can be made on the plantar (plantar) side of the foot.

Some doctors try to treat Morton's neuroma by cutting the intermetatarsal ligament and freeing the nerve from compression under the ligament or any local tissue scarring. This procedure can also be effective. The ultimate success of surgical treatment for Morton's neuroma can be variable.

In cases where the underlying problem is only nerve irritation (true Morton's neuroma), surgery will usually be successful (although full recovery may take several months). In many cases, forefoot pain is more complex. It may be one or two irritated nerves that are causing pain, but the real problem is often excessive stress on the small metatarsal bones. The general term for this condition is metatarsalgia.

Prevention

Morton's neuroma is a disease whose development can be avoided by following simple rules. First of all, prevention of the formation of thickening of the intermetatarsal nerve consists of:

• wearing narrow high-heeled shoes only on special occasions and for a short period of time;
• preference for comfortable shoes as the main ones;
• prevention of flat feet, which consists of performing a special set of exercises, including rolling a ball with the foot and lifting small objects from the floor with the toes;
• performing a foot massage;
• weight control and maintaining it at optimal levels;
• timely treatment of orthopedic disorders;
• refusal to engage in traumatic sports;
• rational loads on the lower limbs;
• timely diagnosis and treatment of foot injuries;
• prevention of the development of atherosclerosis and other vascular disorders, which is mainly achieved through a healthy diet and rational physical activity.

Thus, Morton's neuroma is a harmless, but extremely unpleasant disease, the development of which is much easier to avoid than to then deal with its consequences. Treatment of pathology in the early stages can be carried out using conservative methods, but without correcting habits and footwear it will not be successful. The most reliable and effective method of combating already formed Morton's neuroma is surgery. Modern techniques make it possible to radically solve the problem of pain in less than an hour and return a person to the ability to move without pain. At the same time, operations of this kind are associated with minimal risks of complications, do not require long and complex rehabilitation, and also allow you to return to most everyday activities the very next day after the procedure.