Morton's neuroma medical therapy: Difference between revisions
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==== Conservative therapy for Morton's neuroma ==== | ==== Conservative therapy for Morton's neuroma ==== | ||
* [[Morton's neuroma]] should be [[Managed care|managed]] conservatively before proceeding to expensive [[diagnostic procedures]] | * [[Morton's neuroma]] should be [[Managed care|managed]] conservatively before proceeding to expensive [[diagnostic procedures]] | ||
* Conservative [[Measure (mathematics)|measures]] for pain relief include: | * Conservative [[Measure (mathematics)|measures]] for pain relief include:<ref name="pmid17147793">{{cite journal| author=Kang JH, Chen MD, Chen SC, Hsi WL| title=Correlations between subjective treatment responses and plantar pressure parameters of metatarsal pad treatment in metatarsalgia patients: a prospective study. | journal=BMC Musculoskelet Disord | year= 2006 | volume= 7 | issue= | pages= 95 | pmid=17147793 | doi=10.1186/1471-2474-7-95 | pmc=1712337 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17147793 }} </ref><ref name="pmid17144963">{{cite journal| author=Jannink M, van Dijk H, Ijzerman M, Groothuis-Oudshoorn K, Groothoff J, Lankhurst G| title=Effectiveness of custom-made orthopaedic shoes in the reduction of foot pain and pressure in patients with degenerative disorders of the foot. | journal=Foot Ankle Int | year= 2006 | volume= 27 | issue= 11 | pages= 974-9 | pmid=17144963 | doi=10.1177/107110070602701119 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17144963 }} </ref><ref name="pmid15973088">{{cite journal| author=Hsi WL, Kang JH, Lee XX| title=Optimum position of metatarsal pad in metatarsalgia for pressure relief. | journal=Am J Phys Med Rehabil | year= 2005 | volume= 84 | issue= 7 | pages= 514-20 | pmid=15973088 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15973088 }} </ref><ref name="pmid15153584">{{cite journal| author=Jackson L, Binning J, Potter J| title=Plantar pressures in rheumatoid arthritis using prefabricated metatarsal padding. | journal=J Am Podiatr Med Assoc | year= 2004 | volume= 94 | issue= 3 | pages= 239-45 | pmid=15153584 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15153584 }} </ref><ref name="pmid7894637">{{cite journal| author=Chang AH, Abu-Faraj ZU, Harris GF, Nery J, Shereff MJ| title=Multistep measurement of plantar pressure alterations using metatarsal pads. | journal=Foot Ankle Int | year= 1994 | volume= 15 | issue= 12 | pages= 654-60 | pmid=7894637 | doi=10.1177/107110079401501205 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7894637 }} </ref><ref name="pmid2074081">{{cite journal| author=Holmes GB, Timmerman L| title=A quantitative assessment of the effect of metatarsal pads on plantar pressures. | journal=Foot Ankle | year= 1990 | volume= 11 | issue= 3 | pages= 141-5 | pmid=2074081 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2074081 }} </ref> | ||
** Decreasing pressure on the metatarsal heads by using: | ** Decreasing pressure on the metatarsal heads by using: | ||
*** Metatarsal support | *** Metatarsal support | ||
Revision as of 01:07, 3 June 2019
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Morton's neuroma Microchapters |
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Treatment |
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Morton's neuroma medical therapy On the Web |
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American Roentgen Ray Society Images of Morton's neuroma medical therapy |
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Risk calculators and risk factors for Morton's neuroma medical therapy |
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.
Medical Therapy
- Non-surgical treatment is instituted first
- Physician may recommend any of the following:
Conservative therapy for Morton's neuroma
- Morton's neuroma should be managed conservatively before proceeding to expensive diagnostic procedures
- Conservative measures for pain relief include:[1][2][3][4][5][6]
- Decreasing pressure on the metatarsal heads by using:
- Metatarsal support
- Metatarsal bars
- Metatarsal pads
- Padded shoe insert (it's important to place inserts properly just proximal to the metatarsal head)
- Tapping the toe area
- Orthotics
- Specialized orthopedic shoes
- Shoes with wider toe boxes allowing spread of metatarsal heads
- Determine proper shoe width while standing with the help of a professional shoe fitting device
- Physical therapy
- Strength exercises for intrinsic foot muscles
- Decreasing pressure on the metatarsal heads by using:
Non-conservative medical therapy
- When conservative measures fail, following medical therapy is used for non-surgical treatment of neuroma:
- Tricyclic antidepressants
- Anticonvulsants (more effective)
- Serotonin-norepinephrine reuptake inhibitors
- Ultrasound-guided interdigital injection of following nerve blocking agents via dorsal approach into the site of tenderness:
- Steroid
- Local anaesthetic
- Anti-inflammatory drugs (orally or injected into the toe area)
- Painkillers (not recommended for long-term treatment)
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.