Interdigital Neuroma Morton's Neuroma - Everything You Need To Know - Dr. Nabil Ebraheim
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- Опубліковано 4 жов 2024
- Dr. Ebraheim’s educational animated video describes the condition of interdigital neuroma - Morton's Neuroma.
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Interdigital Neuroma Morton’s Neuroma
Morton’s neuroma is a compressive neuropathy of the interdigital nerve. It occurs most commonly in the third interdigital space. Perineural fibrosis and entrapment of the interdigital nerve may be the cause of this problem. The patient usually describes a forefoot pain on the plantar aspect of the foot, especially during standing and walking. This is usually associated with radiation of tingling and burning into the toes that are affected. The pain is usually localized to a specific area, and it does not involve the entire forefoot. It occurs predominantly between the 3rd and 4th web space in 80% of the time and between the 2nd and 3rd web space 20% of the time. The pain is radiating distally in about 60% of the time and numbness occurs about 40% of the time. When you examine the patient, the area of focal and localized tenderness is in the plantar webspace and not over the joints. The interdigital neuroma (Morton’s neuroma) occurs in middle aged females with forefoot pain that is worse with shoe wear. The pain is worse with weight bearing or wearing tight shoes with high heels. The weight transfer to the metatarsal heads will aggravate the condition. Dorsiflexion of the toes will also aggravate the condition. The symptoms are relieved by removing the shoes and massaging the foot. The paresthesia is most commonly on the plantar aspect of the web space. The patient will have chronic pain in the interdigital space between the 3rd and 4th toes that occasionally radiates down distally into the toes, and the foot exam is normal. Compression test of the web space may be positive. Compression of the metatarsals medially and laterally (squeezing the metatarsals) while pushing on the plantar tissue dorsally. The bursal tissue may crease a “click”, and if this happens it is the classic test. Ultrasound and MRI are helpful, but it is usually not as good as the history and physical examination. MRI has a very limited role in the diagnosis of Morton’s Neuroma. EMG and nerve studies are of little benefit. The history and physical exam is the gold standard for the diagnosis of interdigital neuroma. You can add diagnostic injection to see the result. Injection of local anesthesia into the are of the interdigital nerve can be diagnostic for Morton’s neuroma. Differential diagnoses include metatarsalgia, stress fractures, MTP synovitis, complex regional pain syndrome, arthritis, osteonecrosis of the metatarsal head, neoplasm, and lumbar radiculopathy. X-rays are helpful in excluding metatarsal stress fractures. Consider MTP synovitis especially after digital nerve block. Treatment can be conservative or surgical. To treat conservatively, start with shoe wear modification (no high heals or tight shoes). Conservative treatment also includes injection of steroids. This will give relief of symptoms in 1/3 of the patients with multiple injections. Injection is usually done dorsally, and it may be more diagnostic than therapeutic. Surgery an be neurectomy, done after failure of nonoperative treatment (approach the neuroma through dorsal or plantar approach). Dorsal approach is most commonly used. Incise the transverse metatarsal ligament. Resect the nerve 3 cm proximal to the metatarsal heads. Bury the proximal stump within the intrinsic muscles. If the neuroma is recurrent, then there may be a retained neuroma distal to the metatarsal heads. In this case, you may want to do surgery through the plantar approach, and you may want to do the research of the nerve and transpose it to muscle on the plantar foot (there might be about 70% success rate). The most likely cause of recurrent symptoms following excision of a 3rd web space neuroma is a traumatic neuroma tethered by plantar neural branches. When a recurrent neuroma occurs at the end of the resected nerve, it does not retract far enough because the transection may not be far proximal enough or it may be tethered by the plantar neural branches. Stump neuroma can also occur due to inadequate resection. Causes of surgical failure include resection of the common plantar nerve is too distal, there may be a coexisting tarsal tunnel syndrome, wrong diagnosis, or wrong interdigital space.
![11 BEST Mortons Neuroma Massage, Exercise & Stretch Treatments [WOW!]](http://i.ytimg.com/vi/XsQhGOzPggc/mqdefault.jpg)
![11 BEST Mortons Neuroma Massage, Exercise & Stretch Treatments [WOW!]](/img/tr.png)
My “go to” for excellent explanation of orthopedic issues
Rubber spacer between toes fixed mine 😊
Yes best solution for this problem.
I used a massage therapy gun and pressed it very hard on the nerve it was very painful but it did the job I sometimes need to do it again but it has never reoccured as originally. Hope this helps.
I'm doing this too! Seems to help alleviate the pain for a time. I had a doctor at urgent care diagnose me with planter fasciitis - but I don't have pain anywhere else in the foot but near the base of my toes.
Amazing video and images to go along with the descriptions! So helpful.
Thank you God BLESS you from South Africa
Thanks for the detailed explanation sir👏
Thank you for your videos - always a help and interesting....
Had surgery Made it worse , grew back and it’s like having a large rock in your foot , Chronic pain , ruined my life
Have you investigated cryotherapy?
@@judylloyd7901 is it the same thing as applying ice?…. My MN been hurting for 4 months in my right foot. Got it from excessive JumpRoping 😭
That's a stump neuroma, you need surgery again.
@@815donalduckNo, cryotherapy aka cryosurgery is not the same as applying ice to the area (mortons neuroma). Ice can help alleviate the pain and reduce the inflammation, but it will not get rid of the neuroma.
Grazie signore per questo info😊
It is worse for me in the winter. I have really flat feet, and it’s from playing sports. In the winter the cold causes my entire calf to go numb. It is so annoying and painful, if feels like you have a baseball under your foot. I’ve had forever i really should get done. But mom got done and said you can’t wear flip flops anymore because the nerve is dead there. Anyone know if this is true? The shots never did much of anything or freezing either… so annoying lol
That was spot on, thank you so much
Extraordinary.
Thank you.
Use Toe Separater (Finger Spacer) for this problem. This is a best solution in the space of Surgery.
Perfect. Thanks.
You're welcome!
Could You Sir please explain CRPS Morbus Sudeck issue?
Thank You.
Very helpful and very clear as others said about this lecture
How about Slap lesion ?please
I may have this. Same symptoms but squeeze test negative. It's worst when first getting out of bed, then after walking around all day it improves and almost goes away in the evening. Strange?
Is your pain in the ball of the foot, or is it more widespread? It sounds as though it could be plantar fasciitis, which is a lot easier to treat.
@@judylloyd7901 Only in the ball. I had an ultrasound since I posted here, it showed a ganglion. Not sure how long I'll have these symptoms but kinda getting used to it, at least it's not getting worse. In the meantime I got myself pes anserine tendonits in the other leg - probably from overusing it as the result of my foot pain... what next?...
ive just started having the same problem. mostly when i first wake up. after walking for a while it gets better i’m not sure if its from the cold as it is winter where i am now. i think ive had this problem a few years ago, and it kind of went away on its own. how is your foot now? what did you do to treat it
@@matt17389 Hi, I'm also going through winter now, and recently the problem returned after a few months when I thought it was going away. I noticed that when putting on shoes that were narrow in the toes, at 3am to go to the airport - so quite stressy, but then it got worse over a couple of days when I could barely walk except on soft surface (grass). I had it examined by ultrasound and it turned out to be a ganglion in the same position as morton's neuroma normally happens. My GP suggested aspiration of the fluid, but apparently it can still return. I guess I might give it a go.
@@vickyd7541 thats what i have been experiencing for 2 days now. been sore all day again. in the exact spot morton neuroma is. i got an appointment with my local doctor next. i dont know what ganglion is just yet (going to do some research now) hopefully i dont have that. i have seen alot of videos about mortons neuroma. some say it can go away on its own. other saying you will need injections & possibly surgery. hoping i dont need surgery
Ahh
It was bad years ago. Went through the usual rubbish steps. Innersoles, cortisone injections blah blah. Finally after waiting years on our CRAPPY NHS I had it surgically removed. That was 2014
It is now 2023 and it has returned with a VENGEANCE ! 🤦🏻♂️
This time, I cant even arrange an appointment with my GP about it. So I don’t hold much hope in having the surgery anytime within the next 5 years.
I really wish we could choose wether or not our taxes go towards a service that does not deliver in the NHS.
I don’t want to pay 20% of my annual taxes towards it!!
I want to WALK it is my hobby !!
Me too!! 🚶♀️
Am considering cryotherapy.
@@judylloyd7901 I feel you! JumpRoping is my hobby 😭 ➰💜
I have this for 6yrs no surgery nor injection and I cnt take the pain anymore
I have this condition. Very very painful. Mine was caused by breaking my foot last year.I’ve had steroid injections 2 in eight weeks. One by ultrasound three weeks ago it didn’t work. I have orthotics made by a podiatrist, boots one size bigger and extra wide. The only thing that decreases the inflammation is ice it’s only the smallest bit of relief I get.
How is it going now? Better?
Firstly, give your feet an epsom salt soak in hot water. Then rub with arnica cream or gel. You will be amazed at how much pain this reduces. Do it before you sleep.
Secondly, because I would never consider steroidal injections due to the dangerous effects on the body, and surgery is an absolute no go for me with the small percentage of people it might help, I chose using kinesiology tape AND buying some quality orthotic insoles. The one podiatrist I visited when I couldn't take the pain anymore showed me that my feet were quite flat (years of wearing sandals while living in the tropics). She taped my foot in such a way that I had instant relief. That changed everything for me, so I have learned to tape my own foot. Search UA-cam for some great videos showing how this is done. There are various options. Test some out. I use KT Tape, but there are many other brands with various degrees of stretch.
The combination of the taping & the orthotics (about $45 a pair) has worked wonders, along with occasional foot soaks & arnica cream, with zero side effects, minimal cost compared to surgery & no post-surgery downtime (off work for how long?) or post-surgery pain.
I also make sure that any pair of shoes I buy really support my arches & that they have significant padding in the area where I get flare ups. I've found that shoes with higher tops (ankle support) also make a big difference. At one point this problem got so bad for me that my toes turned purple & were swollen beyond recognition. That really scared me.
The fact that this doctor mentioned none of these solutions - which are far better options that anything he suggested - make me question if he's anything more than a glorified mechanic of body parts. A doctor's degree obviously does not guarantee common sense or logic.
This video describes my issues exactly. I’ve had 2 rounds of shots and I am beginning to feel encouraged. It was about 3 weeks after the second round that it got pretty good. I put those metatarsal gel pads in for a few days and they helped too. I have a pair at home and work but rarely need them now. The pain from this condition is like a strong electrical shock and often it just jolts you when you least expect it. Shoe rotation also helped me.
@@sjt4689 I agree with half of what you say.
I'm having a match on 29 I've done everything which is possible for this problem but it comes and then goes what should i do the match is very important should i play ?
I had a round of 7 shots of steroids and it stayed away 7 years now it is back. So going back to the doc
Aoa
Sir .this same issue with me but i have not expenses efford . If you suggest some excersize who help in relief me pain
Thnku dector👍
Thanks
I have that with chronic pain .I don't know why it is
Do you have an old injury of the foot? Tight fitting shoes can cause this. I have this very painful condition, due to breaking my foot last year. Five fractures I had and severe injuries. Then this developed.
I have this on both feet
Me too
I have it for 6yrs straight now
My foot always pain from number 3 to 5. I don't know why.
Me too. Especially after few hrs of standing.
No swelling no redness nothing just pain!
I never hurt my foot and shoe not tight.
Any tips ? How did y’all heal?
Any tips ? How did y’all heal?
@@joyfulmoment9900Morton's neuroma is often caused by stress on the balls of the feet due to a number of reasons. No swelling, no redness, just pain.
How long does it rake to heal???!!!
For me i used toe spreaders with a pad and it went away in about two months. But a lot of people don't recover
What are your thoughts about cryosurgery for this condition?
I suffer with this pain , do you think if i will do some refloxolgy will help pls?
My wife is a masseuse, definitely helps to reduce the pain and reduces the frequency of re-occurrence. Before massage, the foot was stiff, and it took a while to flex and massage my foot before I achieved the magic 'ckick', which took the agony away. These days a few seconds of manipulation, and I can relieve it.
I get the super pain in the middle of the night... it used to be every second night...these days every month or two.
Bottom line... massage helped a lot. Reduced reoccurrence, reduced the severity of pain. Enhanced the recovery. But didn't make the problem go away.
Good luck,.. its a Pain !
Reflexology is amazing. If you find a good reflexologist, keep going. My grandmother had clients coming to her for treatments from near & far.
I feel numbness. I have bulging disc L5.
I have been diagnosed with Mortons Neuroma , in both feet and extremely painful and debilitating. Do you think accupunture would help?
I'm doing acupuncture to my friend he can feel some relief, not 100% but it's helpfull, and condition is changing
Very painful..i have this for 1 wk already..now i got a fever ..i take pain reliever but still painful & swolen.
@@okezzeko how r u now
So do you treat Mortons Neuroma?
I Can't feel my toes??
Can this be caused by alcohol consumption?
Usually caused by an injury, playing sports, jogging or running, walking barefoot on hard surfaces, flat feet, high arches, wearing high heeled shoes or a too tight toe-box in shoes, or something of that nature.
Alcohol consumption may contribute towards gout, another thing entirely.
my big toe hurts when I walk
B
This narration is appalling.
Must be too lazy to read.
I dont think i jave this condition pwr say nit those 2 toes ate stuck together basically after i hurt my foot and i get cramps that hold to toes upward instead of curling in whoch ive NEVER experienced while im lifting weights.. wouod that be considered the same
Thank You