2024-04-19 09:51:41
Morton’s neuroma is the pathology that everyone is currently talking about, since Queen Letizia suffers from it in her left foot. It is a thickening or benign tumor of the plantar interdigital nerve, that is, the nerve found between the toes. Its most frequent location is between the 3rd and 4th metatarsal. Morton’s neuroma, coincidentally, was a disease related to royalty, since it was described in 1845 by Dr. Durchaler, podiatrist to the Queen of England and later in 1876 it was Dr. Morton, who gave his name to the pathology.
Among the causes of suffering from Morton’s neuroma, the one that has the most weight is the use of high-heeled shoes with a narrow fit, which produces compression of the foot in the part of the toes, causing irritation of the same. For this same reason, Morton’s neuroma is more common in women than in men, generally patients between 40-70 years old. It is a common injury in the normal population and in athletes as well.
The shape of the foot, its width, cavus foot or retraction or shortening, or entrapment of the tibial nerve in the ankle, can favor the appearance of this condition.
The clinical picture may include burning pain in the fingers, electric pain, the sensation of having a stone or a wrinkled sock, even cramps in the fingers, most frequently in the 3rd and 4th fingers.
This pain occurs mainly when the patient is wearing closed shoes. The patient with open shoes will not have pain and therefore, normally, many patients obtain relief with summer shoes.
The diagnosis will be based on the clinical picture, clinical examination (such as lateral forefoot pressure, Mulder’s test, which produces an audible snap of the neuroma when pinched between the metatarsals, or forced dorsiflexion of the toes) and imaging tests, such as magnetic resonance imaging and ultrasound. High-resolution ultrasound is very reliable, faster and cheaper than MRI, is available in many podiatrist and traumatologist offices and allows comparison with the other foot and precise treatment administration.
The differential diagnosis will be made with other causes of metatarsalgia, forefoot pain.
What will the treatment be?
The initial treatment of Morton’s Neuroma will be the use of insoles and the modification of footwear, using a wider one and with less heel.
The second stage of treatment will be infiltrations with corticosteroids and alcohol, which seek to atrophy the neuroma, remove sensitivity and inflammation and reduce its size so that it does not become irritated when rubbing against the metatarsals.
Radiofrequency is a treatment that has been used for many years. With the help of the ultrasound machine, we infiltrate local anesthesia into the Neuroma, with a special needle connected to radiofrequency equipment, which administers a current at high temperature, to achieve the ablation of Morton’s neuroma. That is, it would cause an injury to the nerve, leaving it without sensitivity, as if it were a root canal. It is a technique that is performed in the office, normally does not require sick leave and gives 85% good results. The third phase of treatment is surgery, if the previous ones fail.
Two types of surgery
Ultrasound-guided surgery It is performed with just 1-2 millimeters of incision and under local anesthesia. This form of surgery, with great development and indications in recent years, with publications and scientific endorsements, offers a very quick recovery since the surgical trauma is minimal. The basis of the surgery is to release the intermetatarsal ligament to expand the forefoot space and avoid biomechanical conflict with the metatarsals and nerve irritation.
conventional surgery It consists of removing the nerve, Morton’s neuroma, for which a 3-5 cm incision is made on the dorsum of the foot. This surgery is preferred if the size of the neuroma is very large. Recovery is a little slower than in ultrasound-guided surgery, but in any case the results of both procedures in the hands of experienced surgeons are very satisfactory.
ABOUT THE AUTHOR
Dres Alvaro Iborra and Manuel Villanueva.
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