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Morton´s Neuroma

WHAT IS IT?

Morton’s Neuroma is a disorder that arises when the nerve found between the toes undergoes inflammation. This thickening of the nerve causes the surrounding tissue to compress it and give rise to the symptoms of this injury. This disorder tends to be more common in women than in men and usually affects the nerve that runs between the third and fourth toe.

CAUSES

It is caused by the compression, due to microtraumas, of the plantar nerves which run between the metatarsal bones and under the intermetatarsal transverse ligament. The occurrence of these microtraumas can be favoured by very tight footwear, high heels, being overweight, standing and long walks.

SYMPTOMS

Heightened pain in the forefoot, burning or “parethesia” (sharp tingling) in the toes. Depending on which space between the toes is affected, the symptoms are found in different areas:

• When the “third space” is affected, the symptoms are located between the third and fourth metatarsal bone and in the third and fourth toes.
• When the “second space” is affected, they are located between the second and third metatarsal bone and in the second and third toes.

Typically, pain is alleviated on taking off shoes and massaging the foot. On occasion, it can be asymptomatic.

TREATMENT

• Conservative treatment is similar to that with any metatarsalgia:
• Removal of weight from the limb, including weight loss.
• The use of bar insoles with retrocapital support.
• The use of wide-fitting footwear.

This can be combined with taking non-steroid anti-inflammatory medication and analgesics, cortico-anaesthetics: injections and physiotherapy.

The Arthroscopic Surgery Unit proposes surgical treatment based on treating the Morton’s neuroma as an entrapment syndrome. As such, using percutaneous techniques, the decompression of the affected nerve is carried out via incision of the intermetatarsal transverse ligament. This can be sufficient in pure neuromas without mechanical metatarsalgia. In this case, metatarsal neck osteotomies are combined with percutaneous techniques on the metatarsal bones at the affected space, as for static or mechanical metatarsalgias. This surgery is carried out on an outpatient basis, with local anaesthetic in the foot or sedation and enables the patient to stand on their foot immediately with the use of an orthopedic shoe. Recovery is fast, especially if there is no need to perform osteotomies. If there is, consolidation of the osteotomies, estimated at between six and twelve weeks, and inflammation, will determine progress.

If osteotomies are carried out, the use of  platelet-rich plasma (PRP) in surgery will improve consolidation. In other cases, it will reduce inflammatory reaction.