Assignment # 01

Foot Pathology

Morton’s Neuroma
Submitted to : Sir Waqar Ahmed.
Submitted by : Oshwah Rjaput.
 Morton’s Neuroma
( Morton neuroma, Morton's metatarsalgia,
Intermetatarsal neuroma,
Intermetatarsal space neuroma)

Definition:
A painful condition that affects the ball of the foot due to a swollen
inflamed nerve caused by chronic compression of a branch of planter
nerve between the base of metatarsals commonly between the third and
fourth toe.

Etiology:
The exact cause is still unknown, but wearing high heels and tight
shoes. Injuries to the foot can also be a factor in developing the
condition by changing your foot biomechanics. Poor foot arch control
leading to flat feet or foot overpronation does make you
biomechanically susceptible to a neuroma.

Muscles Involvement:
In the foot, the adductor hallucis muscle, transverse portion (runs
under the ball of the foot) supports the piece of the tripod which runs
from the big toe to the little toe.
Sign and Symptoms:
1- As it is not a true tumor so there is no outward sign can be seen.
2- Inflammation and numbness.
3- May feel as if you are standing on a pebble under your shoe or in
your sock.

Diagnosis:
During examination you will feel a mass or tender spot on the ball of foot.
There may also be a feeling of clicking sound.

Imaging tests
1- X-rays
2- Ultra sound.
3- Magnetic resonance imaging. (MRI)

Conservative Treatment:
1- Changes in footwear.
2- Painkillers.
3- Taping.
4- Steroid Injections.
5- Physiotherapy.
6- NSAID.
Surgical Treatment:
 Decompression surgery. In some cases, surgeons can relieve
the pressure on the nerve by cutting nearby structures, such as
the ligament that binds together some of the bones in the front of
the foot.
 Removal of the nerve. Surgical removal of the growth may be
necessary if other treatments fail to provide pain relief. Although
surgery is usually successful, the procedure can result in
permanent numbness in the affected toes.

Orthotic Treatment:
Traditional orthotic arch supports along with a small foam or fabric
pad positioned under the space between the two affected
metatarsals. This pad helps to splay the metatarsal bones and
create more space for the nerve so as to relieve pressure and
irritation. It may give mild uncomfortable sensations, such as the
feeling of having an awkward object under one's foot. 
References:
1- ICRC lower limb orthotic manual.
2- https://www.mayoclinic.org/diseases-conditions/mortons-neuroma/symptoms-causes/syc-20351935
3- https://www.medicalnewstoday.com/articles/179773#treatment
4- https://comstockpt.com/2015/12/14/mortons-neuroma-why-happen-muscles-sync/
5- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390214/