Morton neuroma

In 1897 Thomas Morton first described the interdigital nerve compression. Morton assumed that the nerves are compressed between the metatarsal heads. Interdigital neuritis is induced by mechanical nerve irritation biomechanics intrinsic and extrinsic factors of plant anatomy to determine a combination of pain, tingling and numbness in the plant.
Neuroma is more common in women and tends to occur in the fifth decade of life, is often exacerbated by tight-fit shoes. Symptoms are typically unilateral. The area affected is three interdigital space followed by two and four. Neuroamele simultaneous plant are rare.Try altering surgical procedures with the participation of local nerve biomechanics.
Morton neuroma etiology is controversial. Neural degeneration showed histologic elements, epineural and perineural fibrosis hyalinisation Endovascular. Morton neuron neural fibrosis is the plantar nerve. There is a nerve tumor and does not contain inflammatory cells or cystic component.
Neuroma is manifested by intermittent episodes of pain. Patients can experience two attacks intro week and then none for a year.Recurrence is variable and tends to become common. Between attacks physical symptoms or signs are missing.
Conservative treatment consists of shoe modifications and manage different types of drugs. The patient should be advised to wear shoes with low heel and wide muzzle. NSAIDs may reduce inflammation around the nerve and relieve some symptoms.Interspaces cortisone injections in the affected level help decrease inflammation. Surgical excision of the neuroma is indicated when conservative therapy has no effect.
Pathogenesis and causes
The term neuroma is a misnomer for the condition. Morton neuroma may be described as a clinical syndrome caused by a variety of factors relating to local anatomy and the forces applied to the plant in the outpatient and shoes.Histolopatologia condition is not a neuroma, but includes some of the following characteristics:Endonervului-sclerosisHyalinisation endoneurale-vessel wallsPerinervului-thickeningDemyelination-nerve fibers.
Anatomical studies show intermetatarsian space collapse in the second and third interspaces. Joint composition allows TARSOMETATARSAL JOINTS hipermobilitatea between second and third metatarsals, contributing to mechanical irritation of the nerve.Sharp tip and narrow shoes may exacerbate the compression between the metatarsal heads and hyperextension of the fingers in high heels and it limits the nerve near the ligament exposed to increased biomechanical stress in outpatient departments. , You rarely metatarsofalangiana pathology: inflamed bursa or lipomas can create common digital nerve compression.
Medial plantar nerve has four branches starting from the medial to the thumb and form common digital nerves of the first, second, third interdigital space. Last innervating plantar nerve and the fourth space, and in 27% of patients contribute to the innervation three interdigital space. Three space narrowness prone to mechanical irritation of the nerve.
Signs and symptoms
Typically patients have localized pain and paresthesia at the plant interspace with radiation in the fingers involved. Symptoms may come and go during several years of development, and are exacerbated by the compression shoe. Improvement appears to descaltare and massage area.A challenge test involves manual compression of the plant and simultaneous palpation of the area affected with other fingers of hands. Runtime Mulder will determine the sign of a painful and palpable click that reproduces the symptoms.
Diagnosis
Imaging Studies:The condition is diagnosed mainly based on history and physical examination. In equivocal cases using ultrasound, magnetic resonance may be helpful.Ultrasound demonstrates hipoechogen part of a mass of tissue that is oriented along the longitudinal axis of the plant. Can be used to test and exclude pathological lesions: lipomas and scholarships.MRI technology brings important information on patoanatomiei plant. Morton neuroma is characteristic of low intensity due to the high degree of fibrous tissue.The differential diagnosis is made with the following conditions: fracture, tendon sheath ganglion, foreign body reaction, nerve sheath tumor, neurpatia peripheral capsule sprain or bursitis plantar metatarsophalangeal joint and capsule.
Treatment
Treatment aims to reduce the effect compression of the planting and removal intermetatarsiana ligament tension. Shoe modifications are simple: high heels and pointed muzzle are avoided. Local therapy with corticosteroids or local anesthetics may be helpful, especially in complicated cases.Other possible physical therapies include cryotherapy, ultrasound, deep tissue massage and stretching exercises. Ice is beneficial to reduce inflammation associated. Phonophoresis can also be used to decrease inflammation and pain.
Surgical therapy:An indication for surgery is severe pain or dysfunction that is not tolerated by the patient and unresponsive to conservative therapy.This involves resection or nerve decompression. Making neurectomiei is considered by some experts that a successful treatment eoarece remove pathological nerve tissue, while only decompression DCE decreases mechanical stress on the nerve that function abnormally.A complication is loss of sensation neurectomiei interdigital skin rash. For most patients this is not clinically significant.Paraesthesia may be present on the plantar skin.Prognosis:Approximately one third of patients operated upon examination shows outstanding sensitivity. Do not report joint instability. Plantar keratosis develops in 15% of cases. Subjective numbness are noted in 50% of patients.