06 juin 2017 ~ 0 Commentaire

Diagnosing Mortons Neuroma

Overview

intermetatarsal neuromaMorton’s neuroma, also called Morton’s metatarsalgia, Morton’s disease, Morton’s neuralgia, Morton metatarsalgia, Morton nerve entrapment, plantar neuroma, or intermetatarsal neuroma is a benign (non-cancerous) growth of nerve tissue (neuroma) that develops in the foot, usually between the third and fourth toes (an intermetatarsal plantar nerve, most commonly of the third and fourth intermetatarsal spaces). It is a common, painful condition.

Causes

Various factors have been implicated in the precipitation of Morton’s neuroma. Morton’s neuroma is known to develop as a result of chronic nerve stress and irritation, particularly with excessive toe dorsiflexion. Poorly fitting and constricting shoes (ie, small toe box) or shoes with heel lifts often contribute to Morton’s neuroma. Women who wear high-heeled shoes for a number of years or men who are required to wear constrictive shoe gear are at risk. A biomechanical theory of causation involves the mechanics of the foot and ankle. For instance, individuals with tight gastrocnemius-soleus muscles or who excessively pronate the foot may compensate by dorsiflexion of the metatarsals subsequently irritating of the interdigital nerve. Certain activities carry increased risk of excessive toe dorsiflexion, such as prolonged walking, running, squatting, and demi-pointe position in ballet.

Symptoms

The most common presenting complaints include pain and dysesthesias in the forefoot and corresponding toes adjacent to the neuroma. Pain is described as sharp and burning, and it may be associated with cramping. Numbness often is observed in the toes adjacent to the neuroma and seems to occur along with episodes of pain. Pain typically is intermittent, as episodes often occur for minutes to hours at a time and have long intervals (ie, weeks to months) between a single or small group of multiple attacks. Some patients describe the sensation as « walking on a marble. » Massage of the affected area offers significant relief. Narrow tight high-heeled shoes aggravate the symptoms. Night pain is reported but is rare.

Diagnosis

A doctor can usually identify Morton’s neuroma during a physical exam. He or she will squeeze or press on the bottom of your foot or squeeze your toes together to see if it hurts. Your doctor may also order an X-ray of your foot to make sure nothing else is causing the pain.

Non Surgical Treatment

Properly resting the foot in addition to the use of appropriate footwear including, as necessary, pads and arch supports, often brings relief from Morton?s Neuroma, without resorting to surgery. A physician may also recommend anti-inflammatory drugs, cortisone injections and, should the condition fail to resolve itself, surgery.plantar neuroma

Surgical Treatment

The above measures are often sufficient to resolve Morton?s Neuroma. Should the condition persist or worsen despite these efforts, surgery may be recommended to remove the Neuroma. The surgery requires only a short recovery period, though permanent numbness in the affected toes can result, so such surgery is generally used as a last resort.

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