03 June 2017 ~ 0 Comments

Diagnosing Mortons Neuroma

Overview

interdigital neuromaMorton’s neuroma is the common name given to the nerve irritation that is found in the ball of the foot that may or may not be accompanied by an inter-metatarsal bursae (a bursa-neuromal complex). It is often associated with inflammation or degeneration and often occurs with constant pressure or irritation of the nerve from the surrounding bony structures or local bursas (fluid filled sacs). Morton’s Neuroma can cause symptoms such as a sharp pain, burning even a lack of feeling in the ball of the foot and associated toes.

Causes

The source of this pain is an enlargment of the sheath of an intermetatarsal nerve in the foot. This usually occurs in the third intermetatarsal space, the space between the third and fourth toes and metatarsals. It occurs here, at the site third intermetatarsal nerve, since this intermetatarsal nerve is the thickest being comprised of the joining of two different nerves. It also may occur in the other intermetatarsal areas, with the second interspace being the next most common location.

Symptoms

The most common symptom of Morton’s neuroma is localized pain in the interspace between the third and fourth toes. It can be sharp or dull, and is worsened by wearing shoes and by walking. Pain usually is less severe when the foot is not bearing weight.

Diagnosis

The most common condition misdiagnosed as Morton’s neuroma is metatarsophalangeal (MTP) joint synovitis. When pain occurs in the third interspace, the clinician may misdiagnose the condition as Morton’s neuroma instead of MTP synovitis, which may manifest very much like Morton’s neuroma. MTP synovitis is distinguished from Morton’s neuroma by subtle swelling around the joint, pain localized mainly within the joint, and pain with forced toe flexion. Palpation of the MTP joint is performed best with a pinching maneuver from the dorsal and plantar aspects of the joint to elicit tenderness of the joint. Other conditions often misdiagnosed as Morton’s neuroma include the following. Stress fracture of the neck of the metatarsal. Rheumatoid arthritis and other systemic arthritic conditions. Hammertoe. Metatarsalgia (ie, plantar tenderness over the metatarsal head) Less common conditions that have overlapping symptoms with Morton’s neuroma include the following. Neoplasms. Metatarsal head osteonecrosis. Freiburg. steochondrosis. Ganglion cysts. Intermetatarsal bursal fluid collections. True neuromas.

Non Surgical Treatment

You may need a metatarsal pad if wider shoes do not help relieve your Morton?s neuroma symptoms. A metatarsal pad will help spread your metatarsal bones and reduce pressure on your affected nerve as it travels under the ball of your foot. The placement of your metatarsal pad is important, and it is best placed by a foot care professional who has experience in the anatomy of the forefoot and Morton?s neuroma treatment.plantar neuroma

Surgical Treatment

Recently, an increasing number of procedures are being performed at specialist centers under radiological or ultrasound guidance. Recent studies have shown excellent results for the treatment of Morton’s neuroma with ultrasound guided steroid injections, ultrasound guided sclerosing alcohol injections, ultrasound guided radiofrequency ablation and ultrasound guided cryo-ablation.

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