Morton neuroma (interdigital neuroma), first described in 1876, is a perineural fibrosis and nerve degeneration of the common digital nerve. Morton neuroma is not a true neuroma, although it results in neuropathic pain in the distribution of the interdigital nerve secondary to repetitive irritation of the nerve.
Treatment strategies for Morton neuroma range from conservative to surgical management. The conservative approach to treating Morton neuroma may benefit from the involvement of a physical therapist. The physical therapist can assist the physician in decisions regarding the modification of footwear, which is the first step to treatment. Recommend soft-soled shoes with a wide toe box and low heel (eg, an athletic shoe). High-heeled narrow nonpadded shoes should not be worn, as they aggravate the condition.
The next step in conservative management is to alter alignment of the metatarsal heads. One recommended action is to elevate the metatarsal head medial and adjacent to the neuroma, thereby preventing compression and irritation of the digital nerve. A plantar pad is used most often for elevation. Have the patient insert a felt or gel pad into the shoe to achieve the desired elevation of the above metatarsal head.
Other possible physical therapy treatment ideas for patients with Morton neuroma include cryotherapy, ultrasound, deep tissue massage, and stretching exercises. Ice is beneficial to decrease the associated inflammation. Phonophoresis also can be used, rather than just ultrasound, to decrease pain and inflammation further.
Surgical excision of the area of fibrosis in the common digital nerve may be curative when conservative measures are unsuccessful. Common adverse outcomes include dysesthesias radiating from a painful nerve stump after surgical excision of the Morton neuroma. Dysesthesias may be treated as any other dysesthetic pain.
Amongst the medications tricyclic medications, anticonvulsants might help.
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