Treatment of Morton's neuroma in ECSTO. How to get rid of foot pain

Morton's neuroma is a fairly common disease characterized by thickening of the lining of the nerves of the foot and causing severe pain. Most often, the disease develops in women as a result of wearing high-heeled shoes, but it can also occur in men. Pain in the foot forces a person to consult a specialist. It is very important to choose the right treatment for Morton's neuroma in order to avoid recurrence of the disease.

An orthopedic traumatologist, Candidate of Medical Sciences, member of the ASTAOR and AAOS Musa Maysigov (Dr. Musa Maysigov).

Let's start from the beginning. If we approach it from the point of view of word formation, then from Greek "neuroma" translates as a nerve tumor, but in fact surgeons call a neuroma the ingrowth of a nerve into a forming scar at the intersection. Most often, such things were formed in amputated limbs: on fingers, leg stumps, etc. Dense scar tissue forms around the nerve, which constantly irritates the nerve, because the scar has a long-term potential for regrowth, and this causes pain. This is called a neuroma. Usually, in neuromas, neurolysis surgery is performed when the tip of the nerve is released from the scar and hides in the muscle in which the scar is formed. Then they began to suggest another name – neurinoma: this is the primary natural tumor of the nerve sheath. What we used to call Morton's neuroma is not a neuroma in the clinical sense of the word - it is not a malignant or benign formation. Morton's neuroma is a cicatricial degeneration of the nerve sheath. In my opinion, the most consistent term is Morton's metatarsalgia, which refers to pain in the forefoot as a result of pinching of the nerve sheath. However, let's not argue with the great ones.

The disease is based on chronic traumatization of the third, less often – the second and even more rarely - the first common interdigital nerves. This happens, contrary to popular belief, not because the bones are pressing on the nerve, but because the ligaments between the bones are pinching it. Being squeezed when walking, the nerve is forced to defend itself, and the nerve sheath is its only weapon. Gradually, the membrane becomes denser in order to reduce the load on the nerve fibers. As a result, the pressure on the nerve does decrease, but the thickened membrane degenerates into a bulky formation.

The second factor is the lowering of the transverse arch of the foot. The arch descends, and we step on it when walking. This leads to the development of chronic and severe pain syndrome.

The disease can occur at any age and develops more often in women due to wearing narrow shoes with high heels. In men, neuroma can develop as a result of flat feet.

The diagnosis is almost always based on a clinical examination, which is usually sufficient. Additional methods include ultrasound and MRI with and without contrast to exclude, for example, tumors.

The first is pain in the area of the third, fourth fingers and closer, at the foot level. Sometimes the pain is accompanied by numbness and shooting in the fingers. It happens that some time after the onset of the disease, wearing any more or less closed shoes leads to unbearable burning pain. Shoes have to be removed immediately, because it becomes impossible to walk. This can happen without much stress on the foot, even in a sitting position. A person is forced to take spare loose shoes with them.

is not uncommon. And most of these patients are women. But, as you know, women are extremely patient, and it happens that they go to the doctor not a month later, but a couple of years after the first symptoms appear, and in such a situation conservative methods are not effective enough.

Conservative treatment methods are possible: pain pills and injections, orthopedic insoles. The effect of painkillers is lower, local injections into this area are more effective: with the hormone cortisol or the alcohol blockade method. Wearing special insoles helps a lot. The most important medicine is to wear wide, comfortable shoes. If nothing helps, we perform an operation.

At ECSTO we perform surgery with both nerve resection and ligament incision which puts pressure on the nerve. With resection, the pain disappears, but at the same time the sensitivity in the area of the third and fourth toes disappears. The main advantage is that relapses are practically eliminated, because the nerve has been removed. Ligament dissection is a faster procedure, lasting just a few minutes and taking place under local anesthesia. Unlike resection, relapses are not possible with this operation. The recurrence rate is higher, but does not exceed a few percent. The patient goes home after a few hours, can lean on his leg without serious discomfort. Working capacity is restored after a few days.

First, I find out what the patient wants. Initially, we offer conservative treatment, but patients often agree to surgery and do not regret it. Conservative therapy should not be carried away, because in any case it is designed for a long time, and often the patient does not have this time. As a rule, I suggest one conservative method – switching to wide, comfortable shoes without heels and narrow noses. And if this method does not help, the question of surgical treatment is raised. I cut the ligament more often – this method is more gentle.

The European Clinic of Sports Traumatology and Orthopedics provides all types of treatment for Morton's neuroma: surgical, medical, injection, orthopedic. However, the effect of conservative therapy may be less pronounced and take longer. You should not be afraid of surgery: treatment is performed on an outpatient basis under local anesthesia, the effect is achieved instantly, and very soon patients return to normal life.