Name
MORTON NEUROMA (INTERDIGITAL NEUROMA)
DESCRIPTION
DETAIL
CAUSES β’ Excessive stress of the forefoot β’ Repetitive trauma β’ Congenitally enlarged plantar digital nerve -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Stress fracture β’ Arthritis β’ Bursitis β’ Foreign bodyCOMPLETE BLOOD TEST - NORMAL SPECIAL TESTS Mulderβs sign - a click and pain produced by squeezing the metatarsal heads together and simultaneously compressing the neuroma between the thumb and index finger of the other FOOT IMAGING β’ Radiographs may help rule out osseous pathology if diagnosis in question β’ Ultrasound - hypoechoic nodule between the metatarsal interspace
TYPENOTES
RISK FACTORS: High heeled and narrow shoes, Pronated foot (flat foot), Obesity, Ballet dancing, basketball, aerobics, tennis, running, etcGENERAL MEASURES β’ Flat shoes with a roomy toe box β’ Metatarsal pads - placed immediately proximal to the two involved metatarsal heads β’ Corticosteroid injection into the dorsal part of the foot with medium- or long-acting steroid (betamethasone or methylprednisolone) mixed with local anesthetic (lidocaine) β’ 80% respond to above measures SURGICAL MEASURES Surgical removal of the neuroma (refractory cases) ACTIVITY Modifying, shortening, or temporarily discontinuing standing, walking or running activities DRUG(S) OF CHOICE Injectable steroids such as betamethasone phosphate/acetate or methylprednisolone - use if conservative measures fail ALTERNATIVE DRUGS NSAIDs for temporary symptom relief PATIENT MONITORING If no improvement after 3 months of conservative treatment, consider corticosteroid injection. Repeat injection if no improvement after 2-4 weeks. PREVENTION/AVOIDANCE Wide toe box and flat heeled shoes POSSIBLE COMPLICATIONS Knee and hip pain related to a change in gait EXPECTED COURSE/PROGNOSIS 40-50% improve after 3 months of conservative treatment, 45-50 % improve after steroid injection, 96% improve after surgery
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
X-RAY FOOT A.P. & LAT. VIEW, COMPLETE BLOOD COUNT, ULTRA SOUND EXAM