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Wednesday, September 23, 2020

Morton’s neuroma and metatarsalgia

Morton’s metatarsalgia is a very uncomfortable syndrome, characterized by foot pain which leads to problems with walking. The cause of this pain is neurological.

Morton’s neurome involves thickening of a small nerve between third and fourth toe which passes under the ligament connecting two bones. At first it was thought of as a tumor, then inflammation, but with time both these theories were cast away. Thickening develops because of irritation, trauma, or pressure, and it is 10 times more common in women.

Symptoms include pain and burning on the front and bottom side of the foot – in the „roots“ of the fingers. It is enhanced after physical activity, especially running and walking, and sometimes just wearing shoes. Numbness is also possible in fingers and front of the foot. Pain will rise if wearing high heels or tight shoes. It is important to rule out other similar conditions – arthritis, rheumatoid arthritis, tendon inflammation, gout – so RTG and ultrasound are advisable. Rarely we use MR to confirm the diagnosis. It is especially important to check for calluses.

Treatment may seem simple, but is not always efficient. Literature usually recommends special inserts, comfortable shoes, anti pain medication, which can also be injected directly along with corticosteroids. If nothing works, surgery is recommended in order to remove the thickened nerve. Results can be satisfying, but not always.

Even though literature almost never mentions physical therapy as an option, our experience says that this method can be a great help. There are two basic options. First one is based on laser  and ultrasound. Ultrasound uses micro vibrations, and laser uses photostimulative and thermal effect to reduce pain. When combined with proprioception exercises, pain can be reduced to zero in most patients. Second option is shockwave therapy which reduces pain receptors sensitivity through hyperstimulative analgesia, again in combination with exercises. With adequate shoes and quality inserts, Morton’s metatarsalgia is treatable and does not need to affect everyday or sport activities.

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