What is Morton’s Neuroma

How does the interdigital nerve of the foot thicken?

The nerves are covered by a layer of myelin that protects them. This protection, like any other structure, is not absolute; nerves can also be subjected to a chronic inflammation due to constant pressure or repeated on them, which generates a thickening of the nerve, especially the one between the third and fourth fingers. Specifically, the metatarsals are the bones at the base of the toes. These are linked together by the metatarsal ligament, which allows them to be mobilized as a structural unit. Al, when the foot lifts off the ground, all the weight of the body falls on the metatarsal area (branches of the plantar nerves that are responsible for the sensitivity of the toes) so that the interdigital nerves are compressed between the ground and the metatarsal ligament. The importance of footwear: Morton's neuroma is more common in women who wear narrow and high-heeled shoes because, with such shoes, the pressure exerted on the area of ​​the interdigital nerves is constant. On the other hand, with flat and wider shoes, the pressure is only exerted at the moment of taking off from the ground when walking.

Factors that favor the appearance of Morton's neuroma

The following factors influence the development of Morton's neuroma:

• Certain toe deformities - Bunions (or hallux valgus), hammer toes, or flat feet predispose Morton's neuroma.
• Frequent high intensity physical activities: performing high intensity sports such as running without proper footwear can promote the appearance of the neuroma. In addition, some sports where you bounce hard on them, such as tennis or squash, also predispose them to their training.

Constant compression on the interdigital nerve causes it to become irritated and thicken, causing pain when walking. A tingling or burning sensation appears, along with a tightening of the plantar area and a feeling of occupation.

Initially, the pain is punctual, when you are on your feet for a long time, do some physical activity or wear narrow and high-heeled shoes, but the pain disappears with rest or more ergonomic footwear. However, over time, the injury becomes chronic and pain persists regardless of footwear or physical activity.

The diagnosis is based on the patient's explanation of the pain, as well as the physical examination of the pain. pain can be reproduced by compressing the affected foot area, in the interdigital area, which is called Mulder's sign. Subsequently, the diagnosis is confirmed by an imaging test, be it an ultrasound or a), which allows to see the neuroma and the involvement of the surrounding structures.

Treatment

The initial treatment is conservative and consists of the use of adequate orthopedics to reduce the pressure on the interdigital space through which the nerves pass, such as cushioned insoles or metatarsal pads that allow better support. It is also important to wear suitable, wide and flat shoes. In addition, during pain crises, you can apply ice to the area (without going directly to the skin) and reduce high-impact physical activity on the area.

Another option at the pharmacological level is to use anti-inflammatory drugs (non-steroidal or oral corticosteroids), or to infiltrate the lesion with corticosteroids or anesthetic substances. Proper physical therapy by a professional can help reduce tension in the area and reduce pain.

If conservative measures are not enough, a surgical intervention can be performed that will seek to eliminate the neuroma by sectioning either the transverse metatarsal ligament together with the affected interdigital nerve, or only the ligament, with an efficiency that ranges between 80% and 90%. . The postoperative period is usually not complicated and patients tolerate it well, although they must rest for a while as they cannot support the operated foot.

Precautionary measures: The basic preventive measures include avoiding high-heeled and narrow shoes, at least very regularly, and doing physical activity in moderation and with adequate equipment. In the event of pain consistent with Morton's neuroma, it is essential to put yourself in the hands of a traumatologist.

• Morton's neuroma consists of inflammation of the interdigital nerve of the foot, specifically the one between the third and fourth toes.
• Standing for a long time, engaging in vigorous physical activities, or wearing narrow and high-heeled footwear favors the development of Morton's neuroma.
• The pain is punctual and disappears with rest or wearing more ergonomic footwear, but over time, the injury becomes chronic and the pain becomes constant.