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Mortons Neuroma Treatments

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Morton neuromaAlso known as Morton's Interdigital Neuroma, Morton's Metatarsalgia, Morton's Neuralgia, Plantar Neuroma, Intermetatarsal Neuroma) What is a Morton's neuroma? Morton's neuroma is a condition characterized by localized swelling of the nerve and soft tissue located between two of the long bones of the foot (metatarsals - figure 1), which can result in pain, pins and needles, or numbness in the forefoot or toes.

Causes

Morton's neuroma is an inflammation caused by a buildup of fibrous tissue on the outer coating of nerves. This fibrous buildup is a reaction to the irritation resulting from nearby bones and ligaments rubbing against the nerves. Irritation can be caused by wearing shoes that are too tight, wearing shoes that place the foot in an awkward position, such as high heels, a foot that is mechanically unstable, repetitive trauma to the foot such as from sports activities like tennis, basketball, and running. Trauma to the foot caused by an injury such as a sprain or fracture. It is unusual for more than one Morton's neuroma to occur on one foot at the same time. It is rare for Morton's neuroma to occur on both feet at the same time.

Symptoms

Neuroma patients occasionally complain of a ?pins and needles? sensation that spreads through their feet, or of a feeling akin to hitting their ?funny bone.? The sensation may be described as similar to an electric shock. Some patients also say that these symptoms, as well as those listed above, will come and go, depending on what they are wearing on their feet, the activity they are doing, or on other external factors.

Diagnosis

A GP (general practitioner, primary care physician) or a podiatrist (foot specialist doctor) will ask the patient to describe the pain as well as its intensity, when symptoms started, what types of shoes are worn, as well as some questions about their job, lifestyle and hobbies. The doctor will then examine the foot and try to locate the affected nerve. This may involve attempting to reproduce symptoms by manipulating the foot. In order to get a detailed image of the inside of the food, one of the following scans may be ordered. X-ray, this is a type of high-energy radiation. In low doses they are used to diagnose diseases and condition by making pictures of the inside of the body. In higher doses they are used to treat cancer. This procedure is non-invasive and painless. Ultrasound scan, high frequency sound waves are pointed at a specific part of the body, which in this case is the foot. The ultrasound waves bounce of tissues; their echoes are then converted into a picture, called a sonogram. This allows the doctor to get an inside view of the foot. This procedure is non-invasive and painless. MRI (magnetic resonance imagining) a device that uses a magnetic field and radio waves to create detailed images of the body. Unlike CT scanning or general x-ray studies, no ionizing radiation is involved with an MRI. This procedure is non-invasive and painless. The doctor will have to rule out other conditions which may have similar symptoms, including capsulitis, bursitis, or Freiberg's disease.

Non Surgical Treatment

Most non-operative treatment is usually successful, although it can take a while to figure out what combination of non-operative treatment works best for each individual patient. Non-operative treatment may include the use of comfort shoe wear. The use of a metatarsal pad to decrease the load through the involved area of the plantar forefoot. A period of activity modification to decrease or eliminate activities, which maybe exacerbating the patient?s symptoms. For example, avoiding long periods of standing or other activities that result in significant repetitive loading to the forefoot can be very helpful. Wearing high heels should be avoided. Local corticosteroid injections can help decrease inflammation associated with the nerve. However, this does not necessarily address the underlying loading forces that maybe causing the injury to the nerve in the first place. It has been proposed that an alcohol injection in and around the nerve will cause a controlled death to the nerve and subsequently eliminate symptoms from the nerve. In theory, this may be helpful. In practice, adequate prospective studies have not demonstrated the benefit of this procedure above and beyond the other standard non-operative treatments available. In addition there is the concern that the alcohol will cause excessive scarring and death of other important structures in the area.Morton neuroma

Surgical Treatment

If symptoms do not respond to any of the above measures then surgery may be suggested. This involves a short 30 minute operation to either remove tissue to take pressure off the nerve or to remove the nerve causing the pain. The surgery can be done as a day case but it will be two or three weeks before you can be fully active on your feet. There may be some lingering numbness afterwards if the nerve is removed. But surgery is successful in around 80% of cases. There is a small risk of complications such as infection and thickening of the skin on the soles of the feet.

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