Morton's neuroma medical therapy: Difference between revisions

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==Overview==
==Overview==


Non-[[Surgery|surgical]] [[Treatments|treatment]] is [[Institute of Medicine|instituted]] first for the [[Treatments|treatment]] of [[morton's neuroma]]. Firstly, the conservative [[Measure (mathematics)|measures]] are [[Usage analysis|used]] for the [[pain relief]] such as decreasing the [[pressure]] on [[Metatarsal|metatarsal heads]] by [[Usage analysis|using]] [[Metatarsals|metatarsal]] [[support]], [[bars]], padded [[shoe insert]] just [[proximal]] to the [[Metatarsal|metatarsal head]], [[Tapping AFM|tapping]] the [[toe]] [[area]], [[orthotics]], [[Specialize|specialized]] [[orthopedic]] [[Shoe insert|shoes]], [[Shoe insert|shoes]] with [[Wide and fast|wider]] [[toe]] [[Box|boxes]] allowing [[Spreading activation|spread]] of [[Metatarsal bones|metatarsal heads]], low [[Heel|heels]], [[Good Friends (Cereal)|good]] [[arch support]] & [[Stiff pattern|stiff]] [[soles]], determining [[Proper linear model|proper]] [[Shoe insert|shoe]] width, [[physical therapy]], [[Massage|massaging]] [[Ball (anatomy)|ball]] of the [[foot]], [[Strength training|strength]] [[exercises]] for [[Intrinsic factor|intrinsic]] [[foot]] [[muscles]], [[stretching]] [[exercises]] for [[foot]] [[tendons]] & [[ligaments]], [[Rest cure|resting]] the [[foot]], applying [[Ice pack|ice packs]] to the [[sore]] [[foot]] [[Area|areas]] and [[weight loss]] in [[overweight]] [[patients]]. When conservative [[Measure (mathematics)|measures]] [[Failure|fail]], [[Medical therapy template|medical therapy]] is [[Usage analysis|used]] which includes [[Tricyclic antidepressant|tricyclic antidepressants]], [[anticonvulsants]], [[Serotonin-norepinephrine reuptake inhibitor|serotonin-norepinephrine reuptake inhibitors]], [[prolotherapy]] via Hackett-Hemwall technique which includes [[ultrasound]]-[[Guidant|guided]] [[Intermetatarsal|interdigital]] [[Injection (medicine)|injection]] of [[Nerve block|nerve blocking]] [[AgentSheets|agents]] such as [[steroids]], [[Local anaesthetic|local anaesthetics]], [[dextrose]], [[Anti-inflammatory drug|anti-inflammatory drugs]] or 4% [[alcohol]] sclerosing [[injections]] via '''[[dorsal]] approach''' into the [[Site management organization|site]] of [[tenderness]], [[oral]] or [[Injected|injectable]] [[Anti-inflammatory drug|anti-inflammatory drugs]] and [[painkillers]].
Non-[[Surgery|surgical]] [[Treatments|treatment]] is [[Institute of Medicine|instituted]] first for the [[Treatments|treatment]] of [[morton's neuroma]]. Firstly, the conservative [[Measure (mathematics)|measures]] are [[Usage analysis|used]] for the [[pain relief]] such as decreasing the [[pressure]] on [[Metatarsal|metatarsal heads]] by [[Usage analysis|using]] [[Metatarsals|metatarsal]] [[support]], [[bars]], padded [[shoe insert]] just [[proximal]] to the [[Metatarsal|metatarsal head]], [[Tapping AFM|tapping]] the [[toe]] [[area]], [[orthotics]], [[Specialize|specialized]] [[orthopedic]] [[Shoe insert|shoes]], [[Shoe insert|shoes]] with [[Wide and fast|wider]] [[toe]] [[Box|boxes]] allowing [[Spreading activation|spread]] of [[Metatarsal bones|metatarsal heads]], low [[Heel|heels]], [[Good Friends (Cereal)|good]] [[arch support]] & [[Stiff pattern|stiff]] [[soles]], determining [[Proper linear model|proper]][[Shoe insert|shoe]]<nowiki/>width, [[physical therapy]], [[Massage|massaging]] [[Ball (anatomy)|ball]] of the [[foot]], [[Strength training|strength]] [[exercises]] for [[Intrinsic factor|intrinsic]] [[foot]] [[muscles]], [[stretching]] [[exercises]] for [[foot]] [[tendons]] & [[ligaments]], [[Rest cure|resting]] the [[foot]], applying [[Ice pack|ice packs]] to the [[sore]] [[foot]] [[Area|areas]] and [[weight loss]] in [[overweight]] [[patients]]. When conservative [[Measure (mathematics)|measures]] [[Failure|fail]], [[Medical therapy template|medical therapy]] is [[Usage analysis|used]] which includes [[Tricyclic antidepressant|tricyclic antidepressants]], [[anticonvulsants]], [[Serotonin-norepinephrine reuptake inhibitor|serotonin-norepinephrine reuptake inhibitors]], [[prolotherapy]] via Hackett-Hemwall technique which includes [[ultrasound]]-[[Guidant|guided]][[Intermetatarsal|interdigital]] [[Injection (medicine)|injection]] of [[Nerve block|nerve blocking]] [[AgentSheets|agents]] such as [[steroids]], [[Local anaesthetic|local anaesthetics]], [[dextrose]], [[Anti-inflammatory drug|anti-inflammatory drugs]] or 4% [[alcohol]] sclerosing [[injections]] via '''[[dorsal]] approach''' into the [[Site management organization|site]] of [[tenderness]], [[oral]] or [[Injected|injectable]] [[Anti-inflammatory drug|anti-inflammatory drugs]] and [[painkillers]].


<nowiki/>'''<nowiki/>'''
==Medical Therapy==
==Medical Therapy==
* [[Treatments|Treatment]] of [[morton's neuroma]] [[Dependency ratio|depends]] on several factors such as:
* [[Treatments|Treatment]] of [[morton's neuroma]] [[Dependency ratio|depends]] on several factors such as:<ref>{{cite web |url=http://faoj.org/tag/intermetatarsal-bursitis/ |title=intermetatarsal bursitis &#124; The Foot and Ankle Online Journal |format= |work= |accessdate=}}</ref>
** Severity of the [[symptoms]]
** Severity of the [[symptoms]]
** Since how long [[symptoms]] have been [[Presenting symptom|present]]
** Since how long [[symptoms]] have been [[Presenting symptom|present]]
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* More [[Effective method|effective]]
* More [[Effective method|effective]]
|-
|-
|'''[[Prolotherapy]]''' ([[Proliferation|proliferative]] [[therapy]]) via Hackett-Hemwall technique which incldues [[ultrasound]]-[[Guided Affective Imagery|guided]] [[Intermetatarsal|interdigital]] [[Injection (medicine)|injection]] of [[Nerve block|nerve blocking]] [[AgentSheets|agents]] (mentioned in next column) via '''[[dorsal]] approach''' into the site of [[tenderness]] [[Help desk|helps]] in temporary [[pain relief]]:<ref name="pmid30208078">{{cite journal| author=Malessy MJA, de Boer R, Muñoz Romero I, Eekhof JLA, van Zwet EW, Kliot M et al.| title=Predictive value of a diagnostic block in focal nerve injury with neuropathic pain when surgery is considered. | journal=PLoS One | year= 2018 | volume= 13 | issue= 9 | pages= e0203345 | pmid=30208078 | doi=10.1371/journal.pone.0203345 | pmc=6135496 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30208078  }} </ref><ref name="pmid23740337">{{cite journal| author=Climent JM, Mondéjar-Gómez F, Rodríguez-Ruiz C, Díaz-Llopis I, Gómez-Gallego D, Martín-Medina P| title=Treatment of Morton neuroma with botulinum toxin A: a pilot study. | journal=Clin Drug Investig | year= 2013 | volume= 33 | issue= 7 | pages= 497-503 | pmid=23740337 | doi=10.1007/s40261-013-0090-0 | pmc=3691490 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23740337  }} </ref><ref name="pmid23636185">{{cite journal| author=Thomson CE, Beggs I, Martin DJ, McMillan D, Edwards RT, Russell D et al.| title=Methylprednisolone injections for the treatment of Morton neuroma: a patient-blinded randomized trial. | journal=J Bone Joint Surg Am | year= 2013 | volume= 95 | issue= 9 | pages= 790-8, S1 | pmid=23636185 | doi=10.2106/JBJS.I.01780 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23636185  }} </ref><ref name="pmid24553891">{{cite journal| author=Schon L| title=An injection of corticosteroid plus anesthetic was more effective than anesthetic alone for Morton neuroma. | journal=J Bone Joint Surg Am | year= 2014 | volume= 96 | issue= 4 | pages= 334 | pmid=24553891 | doi=10.2106/JBJS.9604.ebo028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24553891  }} </ref><ref name="pmid23636203">{{cite journal| author=Smith RW| title=Steroid injection for Morton neuroma - data-based justification. | journal=J Bone Joint Surg Am | year= 2013 | volume= 95 | issue= 9 | pages= e64 | pmid=23636203 | doi=10.2106/JBJS.M.00172 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23636203  }} </ref><ref name="pmid16733414">{{cite journal| author=Haddad-Zebouni S, Elia D, Aoun N, Okais J, Ghossain M| title=[Regression of Morton neuroma after local injection of steroids]. | journal=J Radiol | year= 2006 | volume= 87 | issue= 5 | pages= 566-8 | pmid=16733414 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16733414  }} </ref><ref name="pmid10340428">{{cite journal| author=Basadonna PT, Rucco V, Gasparini D, Onorato A| title=Plantar fat pad atrophy after corticosteroid injection for an interdigital neuroma: a case report. | journal=Am J Phys Med Rehabil | year= 1999 | volume= 78 | issue= 3 | pages= 283-5 | pmid=10340428 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10340428  }} </ref><ref name="pmid7671475">{{cite journal| author=Reddy PD, Zelicof SB, Ruotolo C, Holder J| title=Interdigital neuroma. Local cutaneous changes after corticosteroid injection. | journal=Clin Orthop Relat Res | year= 1995 | volume=  | issue= 317 | pages= 185-7 | pmid=7671475 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7671475  }} </ref><ref name="pmid27301735">{{cite journal| author=van Vendeloo SN, Ettema HB| title=Skin depigmentation along lymph vessels of the lower leg following local corticosteroid injection for interdigital neuroma. | journal=Foot Ankle Surg | year= 2016 | volume= 22 | issue= 2 | pages= 139-41 | pmid=27301735 | doi=10.1016/j.fas.2016.01.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27301735  }} </ref><ref name="pmid29230531">{{cite journal| author=Park YH, Lee JW, Choi GW, Kim HJ| title=Risk factors and the associated cutoff values for failure of corticosteroid injection in treatment of Morton's neuroma. | journal=Int Orthop | year= 2018 | volume= 42 | issue= 2 | pages= 323-329 | pmid=29230531 | doi=10.1007/s00264-017-3707-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29230531  }} </ref><ref name="pmid26869493">{{cite journal| author=Mahadevan D, Salmasi M, Whybra N, Nanda A, Gaba S, Mangwani J| title=What factors predict the need for further intervention following corticosteroid injection of Morton's neuroma? | journal=Foot Ankle Surg | year= 2016 | volume= 22 | issue= 1 | pages= 9-11 | pmid=26869493 | doi=10.1016/j.fas.2015.03.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26869493  }} </ref><ref name="pmid27037432">{{cite journal| author=Mahadevan D, Attwal M, Bhatt R, Bhatia M| title=Corticosteroid injection for Morton's neuroma with or without ultrasound guidance: a randomised controlled trial. | journal=Bone Joint J | year= 2016 | volume= 98-B | issue= 4 | pages= 498-503 | pmid=27037432 | doi=10.1302/0301-620X.98B4.36880 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27037432  }} </ref><ref name="pmid22585530">{{cite journal| author=Yap LP, McNally E| title=Patient's assessment of discomfort during ultrasound-guided injection of Morton's neuroma: selecting the optimal approach. | journal=J Clin Ultrasound | year= 2012 | volume= 40 | issue= 6 | pages= 330-4 | pmid=22585530 | doi=10.1002/jcu.21926 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22585530  }} </ref><ref name="pmid17515373">{{cite journal| author=Hughes RJ, Ali K, Jones H, Kendall S, Connell DA| title=Treatment of Morton's neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases. | journal=AJR Am J Roentgenol | year= 2007 | volume= 188 | issue= 6 | pages= 1535-9 | pmid=17515373 | doi=10.2214/AJR.06.1463 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17515373  }} </ref><ref name="pmid8722878">{{cite journal| author=Wu KK| title=Morton's interdigital neuroma: a clinical review of its etiology, treatment, and results. | journal=J Foot Ankle Surg | year= 1996 | volume= 35 | issue= 2 | pages= 112-9; discussion 187-8 | pmid=8722878 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8722878  }} </ref><ref name="pmid8620640">{{cite journal| author=Rasmussen MR, Kitaoka HB, Patzer GL| title=Nonoperative treatment of plantar interdigital neuroma with a single corticosteroid injection. | journal=Clin Orthop Relat Res | year= 1996 | volume=  | issue= 326 | pages= 188-93 | pmid=8620640 | doi=10.1097/00003086-199605000-00022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8620640  }} </ref><ref name="pmid18510900">{{cite journal| author=Markovic M, Crichton K, Read JW, Lam P, Slater HK| title=Effectiveness of ultrasound-guided corticosteroid injection in the treatment of Morton's neuroma. | journal=Foot Ankle Int | year= 2008 | volume= 29 | issue= 5 | pages= 483-7 | pmid=18510900 | doi=10.3113/FAI.2008.0483 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18510900  }} </ref><ref name="pmid18751769">{{cite journal| author=Sofka CM, Adler RS, Ciavarra GA, Pavlov H| title=Ultrasound-guided interdigital neuroma injections: short-term clinical outcomes after a single percutaneous injection--preliminary results. | journal=HSS J | year= 2007 | volume= 3 | issue= 1 | pages= 44-9 | pmid=18751769 | doi=10.1007/s11420-006-9029-9 | pmc=2504098 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18751769  }} </ref><ref name="pmid17515235">{{cite journal| author=Hassouna H, Singh D, Taylor H, Johnson S| title=Ultrasound guided steroid injection in the treatment of interdigital neuralgia. | journal=Acta Orthop Belg | year= 2007 | volume= 73 | issue= 2 | pages= 224-9 | pmid=17515235 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17515235  }} </ref>
|'''[[Prolotherapy]]''' ([[Proliferation|proliferative]] [[therapy]]) via '''Hackett-Hemwall technique''' which includes [[ultrasound]]-[[Guided Affective Imagery|guided]] [[Intermetatarsal|interdigital]] [[Injection (medicine)|injection]] of [[Nerve block|nerve blocking]] [[AgentSheets|agents]] (mentioned in next column) via '''[[dorsal]] approach''' into the site of [[tenderness]] [[Help desk|helps]] in temporary [[pain relief]]:<ref name="pmid30208078">{{cite journal| author=Malessy MJA, de Boer R, Muñoz Romero I, Eekhof JLA, van Zwet EW, Kliot M et al.| title=Predictive value of a diagnostic block in focal nerve injury with neuropathic pain when surgery is considered. | journal=PLoS One | year= 2018 | volume= 13 | issue= 9 | pages= e0203345 | pmid=30208078 | doi=10.1371/journal.pone.0203345 | pmc=6135496 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30208078  }} </ref><ref name="pmid23740337">{{cite journal| author=Climent JM, Mondéjar-Gómez F, Rodríguez-Ruiz C, Díaz-Llopis I, Gómez-Gallego D, Martín-Medina P| title=Treatment of Morton neuroma with botulinum toxin A: a pilot study. | journal=Clin Drug Investig | year= 2013 | volume= 33 | issue= 7 | pages= 497-503 | pmid=23740337 | doi=10.1007/s40261-013-0090-0 | pmc=3691490 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23740337  }} </ref><ref name="pmid23636185">{{cite journal| author=Thomson CE, Beggs I, Martin DJ, McMillan D, Edwards RT, Russell D et al.| title=Methylprednisolone injections for the treatment of Morton neuroma: a patient-blinded randomized trial. | journal=J Bone Joint Surg Am | year= 2013 | volume= 95 | issue= 9 | pages= 790-8, S1 | pmid=23636185 | doi=10.2106/JBJS.I.01780 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23636185  }} </ref><ref name="pmid24553891">{{cite journal| author=Schon L| title=An injection of corticosteroid plus anesthetic was more effective than anesthetic alone for Morton neuroma. | journal=J Bone Joint Surg Am | year= 2014 | volume= 96 | issue= 4 | pages= 334 | pmid=24553891 | doi=10.2106/JBJS.9604.ebo028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24553891  }} </ref><ref name="pmid23636203">{{cite journal| author=Smith RW| title=Steroid injection for Morton neuroma - data-based justification. | journal=J Bone Joint Surg Am | year= 2013 | volume= 95 | issue= 9 | pages= e64 | pmid=23636203 | doi=10.2106/JBJS.M.00172 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23636203  }} </ref><ref name="pmid16733414">{{cite journal| author=Haddad-Zebouni S, Elia D, Aoun N, Okais J, Ghossain M| title=[Regression of Morton neuroma after local injection of steroids]. | journal=J Radiol | year= 2006 | volume= 87 | issue= 5 | pages= 566-8 | pmid=16733414 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16733414  }} </ref><ref name="pmid10340428">{{cite journal| author=Basadonna PT, Rucco V, Gasparini D, Onorato A| title=Plantar fat pad atrophy after corticosteroid injection for an interdigital neuroma: a case report. | journal=Am J Phys Med Rehabil | year= 1999 | volume= 78 | issue= 3 | pages= 283-5 | pmid=10340428 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10340428  }} </ref><ref name="pmid7671475">{{cite journal| author=Reddy PD, Zelicof SB, Ruotolo C, Holder J| title=Interdigital neuroma. Local cutaneous changes after corticosteroid injection. | journal=Clin Orthop Relat Res | year= 1995 | volume=  | issue= 317 | pages= 185-7 | pmid=7671475 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7671475  }} </ref><ref name="pmid27301735">{{cite journal| author=van Vendeloo SN, Ettema HB| title=Skin depigmentation along lymph vessels of the lower leg following local corticosteroid injection for interdigital neuroma. | journal=Foot Ankle Surg | year= 2016 | volume= 22 | issue= 2 | pages= 139-41 | pmid=27301735 | doi=10.1016/j.fas.2016.01.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27301735  }} </ref><ref name="pmid29230531">{{cite journal| author=Park YH, Lee JW, Choi GW, Kim HJ| title=Risk factors and the associated cutoff values for failure of corticosteroid injection in treatment of Morton's neuroma. | journal=Int Orthop | year= 2018 | volume= 42 | issue= 2 | pages= 323-329 | pmid=29230531 | doi=10.1007/s00264-017-3707-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29230531  }} </ref><ref name="pmid26869493">{{cite journal| author=Mahadevan D, Salmasi M, Whybra N, Nanda A, Gaba S, Mangwani J| title=What factors predict the need for further intervention following corticosteroid injection of Morton's neuroma? | journal=Foot Ankle Surg | year= 2016 | volume= 22 | issue= 1 | pages= 9-11 | pmid=26869493 | doi=10.1016/j.fas.2015.03.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26869493  }} </ref><ref name="pmid27037432">{{cite journal| author=Mahadevan D, Attwal M, Bhatt R, Bhatia M| title=Corticosteroid injection for Morton's neuroma with or without ultrasound guidance: a randomised controlled trial. | journal=Bone Joint J | year= 2016 | volume= 98-B | issue= 4 | pages= 498-503 | pmid=27037432 | doi=10.1302/0301-620X.98B4.36880 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27037432  }} </ref><ref name="pmid22585530">{{cite journal| author=Yap LP, McNally E| title=Patient's assessment of discomfort during ultrasound-guided injection of Morton's neuroma: selecting the optimal approach. | journal=J Clin Ultrasound | year= 2012 | volume= 40 | issue= 6 | pages= 330-4 | pmid=22585530 | doi=10.1002/jcu.21926 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22585530  }} </ref><ref name="pmid17515373">{{cite journal| author=Hughes RJ, Ali K, Jones H, Kendall S, Connell DA| title=Treatment of Morton's neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases. | journal=AJR Am J Roentgenol | year= 2007 | volume= 188 | issue= 6 | pages= 1535-9 | pmid=17515373 | doi=10.2214/AJR.06.1463 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17515373  }} </ref><ref name="pmid8722878">{{cite journal| author=Wu KK| title=Morton's interdigital neuroma: a clinical review of its etiology, treatment, and results. | journal=J Foot Ankle Surg | year= 1996 | volume= 35 | issue= 2 | pages= 112-9; discussion 187-8 | pmid=8722878 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8722878  }} </ref><ref name="pmid8620640">{{cite journal| author=Rasmussen MR, Kitaoka HB, Patzer GL| title=Nonoperative treatment of plantar interdigital neuroma with a single corticosteroid injection. | journal=Clin Orthop Relat Res | year= 1996 | volume=  | issue= 326 | pages= 188-93 | pmid=8620640 | doi=10.1097/00003086-199605000-00022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8620640  }} </ref><ref name="pmid18510900">{{cite journal| author=Markovic M, Crichton K, Read JW, Lam P, Slater HK| title=Effectiveness of ultrasound-guided corticosteroid injection in the treatment of Morton's neuroma. | journal=Foot Ankle Int | year= 2008 | volume= 29 | issue= 5 | pages= 483-7 | pmid=18510900 | doi=10.3113/FAI.2008.0483 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18510900  }} </ref><ref name="pmid18751769">{{cite journal| author=Sofka CM, Adler RS, Ciavarra GA, Pavlov H| title=Ultrasound-guided interdigital neuroma injections: short-term clinical outcomes after a single percutaneous injection--preliminary results. | journal=HSS J | year= 2007 | volume= 3 | issue= 1 | pages= 44-9 | pmid=18751769 | doi=10.1007/s11420-006-9029-9 | pmc=2504098 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18751769  }} </ref><ref name="pmid17515235">{{cite journal| author=Hassouna H, Singh D, Taylor H, Johnson S| title=Ultrasound guided steroid injection in the treatment of interdigital neuralgia. | journal=Acta Orthop Belg | year= 2007 | volume= 73 | issue= 2 | pages= 224-9 | pmid=17515235 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17515235  }} </ref><ref>{{cite web |url=http://faoj.org/tag/intermetatarsal-bursitis/ |title=intermetatarsal bursitis &#124; The Foot and Ankle Online Journal |format= |work= |accessdate=}}</ref>
{|
|
[[File:Prolotherapy.jpg|thumb|200px|none|Prolotherapist injecting the third interdigital space with sclerosant solution.[http://faoj.org/wp-content/uploads/2012/06/prolotherapy.pdf Source: Ross A. Hauser. et al.]]]
|}
|
|
* [[Corticosteroids|Corticosteroids:]]
* [[Corticosteroids|Corticosteroids:]]
Line 78: Line 83:
*** [[Weight gain]]  
*** [[Weight gain]]  
* [[Local anaesthetic]]
* [[Local anaesthetic]]
*[[Dextrose]]
*[[Dextrose]] ([[Reduced|reduces]] [[pain]] [[Leveling effect|levels]] and [[Improving agent|improves]] [[Quality Initiative|quality]] of various [[life]] concerns)
* [[Anti-inflammatory drug|Anti-inflammatory drugs]]
* [[Anti-inflammatory drug|Anti-inflammatory drugs]]
* 4% [[alcohol]] sclerosing [[injections|injections:]]<ref name="GurdeziWhite2013">{{cite journal|last1=Gurdezi|first1=Sabahat|last2=White|first2=Thomas|last3=Ramesh|first3=Palanisamy|title=Alcohol Injection for Morton’s Neuroma|journal=Foot & Ankle International|volume=34|issue=8|year=2013|pages=1064–1067|issn=1071-1007|doi=10.1177/1071100713489555}}</ref> (84-89% success [[rate]])
* 4% [[alcohol]] sclerosing [[injections|injections:]]<ref name="GurdeziWhite2013">{{cite journal|last1=Gurdezi|first1=Sabahat|last2=White|first2=Thomas|last3=Ramesh|first3=Palanisamy|title=Alcohol Injection for Morton’s Neuroma|journal=Foot & Ankle International|volume=34|issue=8|year=2013|pages=1064–1067|issn=1071-1007|doi=10.1177/1071100713489555}}</ref>
**[[Typical set|Typically]] administered every 7 to 10 [[Day spa|days]]
**[[Typical set|Typically]] administered every 7 to 10 [[Day spa|days]]
** Between [[Four-potential|four]] and [[Seven Sleepers|seven]] [[injections]] are usually needed for [[maximum]] [[Pain relief|relief]]
** Between [[Four-potential|four]] and [[Seven Sleepers|seven]] [[injections]] are usually needed for [[maximum]] [[Pain relief|relief]]

Latest revision as of 18:20, 26 June 2019

Morton's neuroma Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2]Faizan Sheraz, M.D. [3]

Overview

Non-surgical treatment is instituted first for the treatment of morton's neuroma. Firstly, the conservative measures are used for the pain relief such as decreasing the pressure on metatarsal heads by using metatarsal support, bars, padded shoe insert just proximal to the metatarsal head, tapping the toe area, orthotics, specialized orthopedic shoes, shoes with wider toe boxes allowing spread of metatarsal heads, low heels, good arch support & stiff soles, determining propershoewidth, physical therapy, massaging ball of the foot, strength exercises for intrinsic foot muscles, stretching exercises for foot tendons & ligaments, resting the foot, applying ice packs to the sore foot areas and weight loss in overweight patients. When conservative measures fail, medical therapy is used which includes tricyclic antidepressants, anticonvulsants, serotonin-norepinephrine reuptake inhibitors, prolotherapy via Hackett-Hemwall technique which includes ultrasound-guidedinterdigital injection of nerve blocking agents such as steroids, local anaesthetics, dextrose, anti-inflammatory drugs or 4% alcohol sclerosing injections via dorsal approach into the site of tenderness, oral or injectable anti-inflammatory drugs and painkillers.

Medical Therapy

Medical therapy for Morton's neuroma
Type of medical therapy Components
Conservative medical therapy
Decreasing pressure & compression on the metatarsal heads and nerve
Applying ice packs to the sore foot areas helps in reducing the swelling
Physical therapy
Massaging ball of the foot
Strength exercises for intrinsic foot muscles
Stretching exercises in order to loosen the ligaments and tendons of the foot
Resting the foot
Weight loss in overweight patients may also help
Non-conservative medical therapy
Tricyclic antidepressants
Serotonin-norepinephrine reuptake inhibitors
Anticonvulsants
Prolotherapy (proliferative therapy) via Hackett-Hemwall technique which includes ultrasound-guided interdigital injection of nerve blocking agents (mentioned in next column) via dorsal approach into the site of tenderness helps in temporary pain relief:[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]
Prolotherapist injecting the third interdigital space with sclerosant solution.Source: Ross A. Hauser. et al.
Anti-inflammatory drugs (orally or injected into the toe area) Shouldn't be used for long-term treatment
Painkillers

References

  1. ↑ "intermetatarsal bursitis | The Foot and Ankle Online Journal".
  2. ↑ Kang JH, Chen MD, Chen SC, Hsi WL (2006). "Correlations between subjective treatment responses and plantar pressure parameters of metatarsal pad treatment in metatarsalgia patients: a prospective study". BMC Musculoskelet Disord. 7: 95. doi:10.1186/1471-2474-7-95. PMC 1712337. PMID 17147793.
  3. ↑ Jannink M, van Dijk H, Ijzerman M, Groothuis-Oudshoorn K, Groothoff J, Lankhurst G (2006). "Effectiveness of custom-made orthopaedic shoes in the reduction of foot pain and pressure in patients with degenerative disorders of the foot". Foot Ankle Int. 27 (11): 974–9. doi:10.1177/107110070602701119. PMID 17144963.
  4. ↑ Hsi WL, Kang JH, Lee XX (2005). "Optimum position of metatarsal pad in metatarsalgia for pressure relief". Am J Phys Med Rehabil. 84 (7): 514–20. PMID 15973088.
  5. ↑ Jackson L, Binning J, Potter J (2004). "Plantar pressures in rheumatoid arthritis using prefabricated metatarsal padding". J Am Podiatr Med Assoc. 94 (3): 239–45. PMID 15153584.
  6. ↑ Chang AH, Abu-Faraj ZU, Harris GF, Nery J, Shereff MJ (1994). "Multistep measurement of plantar pressure alterations using metatarsal pads". Foot Ankle Int. 15 (12): 654–60. doi:10.1177/107110079401501205. PMID 7894637.
  7. ↑ Holmes GB, Timmerman L (1990). "A quantitative assessment of the effect of metatarsal pads on plantar pressures". Foot Ankle. 11 (3): 141–5. PMID 2074081.
  8. ↑ Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016
  9. ↑ Malessy MJA, de Boer R, Muñoz Romero I, Eekhof JLA, van Zwet EW, Kliot M; et al. (2018). "Predictive value of a diagnostic block in focal nerve injury with neuropathic pain when surgery is considered". PLoS One. 13 (9): e0203345. doi:10.1371/journal.pone.0203345. PMC 6135496. PMID 30208078.
  10. ↑ Climent JM, Mondéjar-Gómez F, Rodríguez-Ruiz C, Díaz-Llopis I, Gómez-Gallego D, Martín-Medina P (2013). "Treatment of Morton neuroma with botulinum toxin A: a pilot study". Clin Drug Investig. 33 (7): 497–503. doi:10.1007/s40261-013-0090-0. PMC 3691490. PMID 23740337.
  11. ↑ Thomson CE, Beggs I, Martin DJ, McMillan D, Edwards RT, Russell D; et al. (2013). "Methylprednisolone injections for the treatment of Morton neuroma: a patient-blinded randomized trial". J Bone Joint Surg Am. 95 (9): 790–8, S1. doi:10.2106/JBJS.I.01780. PMID 23636185.
  12. ↑ Schon L (2014). "An injection of corticosteroid plus anesthetic was more effective than anesthetic alone for Morton neuroma". J Bone Joint Surg Am. 96 (4): 334. doi:10.2106/JBJS.9604.ebo028. PMID 24553891.
  13. ↑ Smith RW (2013). "Steroid injection for Morton neuroma - data-based justification". J Bone Joint Surg Am. 95 (9): e64. doi:10.2106/JBJS.M.00172. PMID 23636203.
  14. ↑ Haddad-Zebouni S, Elia D, Aoun N, Okais J, Ghossain M (2006). "[Regression of Morton neuroma after local injection of steroids]". J Radiol. 87 (5): 566–8. PMID 16733414.
  15. ↑ Basadonna PT, Rucco V, Gasparini D, Onorato A (1999). "Plantar fat pad atrophy after corticosteroid injection for an interdigital neuroma: a case report". Am J Phys Med Rehabil. 78 (3): 283–5. PMID 10340428.
  16. ↑ Reddy PD, Zelicof SB, Ruotolo C, Holder J (1995). "Interdigital neuroma. Local cutaneous changes after corticosteroid injection". Clin Orthop Relat Res (317): 185–7. PMID 7671475.
  17. ↑ van Vendeloo SN, Ettema HB (2016). "Skin depigmentation along lymph vessels of the lower leg following local corticosteroid injection for interdigital neuroma". Foot Ankle Surg. 22 (2): 139–41. doi:10.1016/j.fas.2016.01.002. PMID 27301735.
  18. ↑ Park YH, Lee JW, Choi GW, Kim HJ (2018). "Risk factors and the associated cutoff values for failure of corticosteroid injection in treatment of Morton's neuroma". Int Orthop. 42 (2): 323–329. doi:10.1007/s00264-017-3707-8. PMID 29230531.
  19. ↑ Mahadevan D, Salmasi M, Whybra N, Nanda A, Gaba S, Mangwani J (2016). "What factors predict the need for further intervention following corticosteroid injection of Morton's neuroma?". Foot Ankle Surg. 22 (1): 9–11. doi:10.1016/j.fas.2015.03.007. PMID 26869493.
  20. ↑ Mahadevan D, Attwal M, Bhatt R, Bhatia M (2016). "Corticosteroid injection for Morton's neuroma with or without ultrasound guidance: a randomised controlled trial". Bone Joint J. 98-B (4): 498–503. doi:10.1302/0301-620X.98B4.36880. PMID 27037432.
  21. ↑ Yap LP, McNally E (2012). "Patient's assessment of discomfort during ultrasound-guided injection of Morton's neuroma: selecting the optimal approach". J Clin Ultrasound. 40 (6): 330–4. doi:10.1002/jcu.21926. PMID 22585530.
  22. ↑ Hughes RJ, Ali K, Jones H, Kendall S, Connell DA (2007). "Treatment of Morton's neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases". AJR Am J Roentgenol. 188 (6): 1535–9. doi:10.2214/AJR.06.1463. PMID 17515373.
  23. ↑ Wu KK (1996). "Morton's interdigital neuroma: a clinical review of its etiology, treatment, and results". J Foot Ankle Surg. 35 (2): 112–9, discussion 187-8. PMID 8722878.
  24. ↑ Rasmussen MR, Kitaoka HB, Patzer GL (1996). "Nonoperative treatment of plantar interdigital neuroma with a single corticosteroid injection". Clin Orthop Relat Res (326): 188–93. doi:10.1097/00003086-199605000-00022. PMID 8620640.
  25. ↑ Markovic M, Crichton K, Read JW, Lam P, Slater HK (2008). "Effectiveness of ultrasound-guided corticosteroid injection in the treatment of Morton's neuroma". Foot Ankle Int. 29 (5): 483–7. doi:10.3113/FAI.2008.0483. PMID 18510900.
  26. ↑ Sofka CM, Adler RS, Ciavarra GA, Pavlov H (2007). "Ultrasound-guided interdigital neuroma injections: short-term clinical outcomes after a single percutaneous injection--preliminary results". HSS J. 3 (1): 44–9. doi:10.1007/s11420-006-9029-9. PMC 2504098. PMID 18751769.
  27. ↑ Hassouna H, Singh D, Taylor H, Johnson S (2007). "Ultrasound guided steroid injection in the treatment of interdigital neuralgia". Acta Orthop Belg. 73 (2): 224–9. PMID 17515235.
  28. ↑ "intermetatarsal bursitis | The Foot and Ankle Online Journal".
  29. ↑ Gurdezi, Sabahat; White, Thomas; Ramesh, Palanisamy (2013). "Alcohol Injection for Morton's Neuroma". Foot & Ankle International. 34 (8): 1064–1067. doi:10.1177/1071100713489555. ISSN 1071-1007.


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