The diagnosis
The diagnosis consists of the appropriate symptoms, the exclusion of other diseases and, in this case, a correspondingly proving imaging. In addition to pain while walking, coupled with the numbness, the pain character gives a decisive indication for the correct diagnosis. However, in order to ensure this, the foot must be examined either by means of an ultrasound machine or an MRI.
Here the thickening of the nerve can be made visible. Any non-radiologist would probably find it very difficult to evaluate the MRI image. MRI is used to look at individual “body sections”, which can be used to look at the inside of a person in the corresponding area.
On closer examination, one can see a thickened nerve between the metatarsals. As a rule, only one nerve is affected – the one between the third and fourth metatarsal bones – and is therefore the only one that is thickened. The remaining nerves thus provide a good reference value to which one can refer and which represent the normal case.
The conservative therapy
Since Morton’s neuralgia is not a malignant disease, conservative therapy should generally be given priority. Possible treatment concepts could be the use of insoles in combination with physiotherapy.With the help of these two adjusting screws, an attempt is then usually made to correct the underlying foot malposition, which should also result in pain relief. If this approach is no longer sufficient or if a foot malposition is not the causal problem, the injection of local anesthetics can be started.
The medication is distributed around the Morton’s neuroma, thus preventing the pain from the foot from making its way to the brain. Furthermore, the local use of cortisone can suppress the irritation-related immune reaction of the body. The increase in thickness of the nerve is thus slowed down.
However, if the problem is already so far advanced, the local anesthetics only provide pain relief for a few days, so that surgery usually follows to eliminate the cause of the pain and not just to combat the symptomsThe first stage of therapy usually consists of injecting a locally effective anesthetic at the appropriate point in the foot to block the transmission of pain by the nerve. However, this does not provide permanent pain relief and lasts for a few days at most. Although this procedure can be repeated, it does not usually lead to the desired success, so that surgery to remove nerve swelling is usually the ultima ratio.
In some circles, acupuncture is also said to have a pain-relieving effect. Whether this is successful, however, varies from person to person. More information about local anesthetics – the local anesthetic can be found here.
A cortisone injection can help, but does so at the cost of certain side effects. However, a cortisone injection alone is not enough to stop the nerve from growing thicker. Rather, cortisone injections must be administered regularly as the cortisone concentration drops over time.
However, cortisone tends to cause more central side effects than other drugs, so its use should be well-considered. The disease cannot be stopped by the administration of cortisone, which is why it is usually used in combination with a local anaesthetic to relieve pain, which cortisone is not able to do. Insoles are usually the first conservative step in the treatment of pain in Morton Neuromas.
They are able to correct a foot malposition, which often precedes Morton Neuromas. Mostly it is the splayfoot syndrome, in which insoles contribute to a relief of the metatarsus and thus also give the affected nerves more room to move without being irritated by the metatarsals. As a rule, the health insurance company will cover the costs of the insoles, which is why this conservative treatment method should definitely be considered.
Foot gymnastics is usually prescribed with insoles that provide relief. The affected persons are taught various exercises that serve the treatment of the splayfoot syndrome. However, people without a causal foot malposition can also benefit from it by developing gaits together with a physiotherapist that relieve the metatarsus and thus contribute to pain reduction.
