Difference between revisions of "Morton's neuroma medical therapy"

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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]], 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]], [[ultrasound]]-[[Guidant|guided]] [[Intermetatarsal|interdigital]] [[Injection (medicine)|injection]] of [[Nerve block|nerve blocking]] [[AgentSheets|agents]] such as [[steroids]], [[Local anaesthetic|local anaesthetics]], [[Anti-inflammatory drug|anti-inflammatory drugs]] or [[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]] 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]], [[ultrasound]]-[[Guidant|guided]] [[Intermetatarsal|interdigital]] [[Injection (medicine)|injection]] of [[Nerve block|nerve blocking]] [[AgentSheets|agents]] such as [[steroids]], [[Local anaesthetic|local anaesthetics]], [[Anti-inflammatory drug|anti-inflammatory drugs]] or [[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]].
  
 
==Medical Therapy==
 
==Medical Therapy==
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** [[Metatarsal]] pads
 
** [[Metatarsal]] pads
 
** [[Toe]] [[Crestor|crest]] pads
 
** [[Toe]] [[Crestor|crest]] pads
* [[Tapping AFM|Tapping]] the [[toe]] [[area]]
+
* [[Tapping AFM|Tapping]]/[[Splint (medicine)|splinting]] the [[toe]] [[area]]
 
* [[Shoe insert|Shoe inserts]] ([[orthotics]]) [[Help Menu|help]] in [[Correction (newspaper)|correcting]] any [[Mechanical energy|mechanical]] [[imbalance]] in the [[foot]]
 
* [[Shoe insert|Shoe inserts]] ([[orthotics]]) [[Help Menu|help]] in [[Correction (newspaper)|correcting]] any [[Mechanical energy|mechanical]] [[imbalance]] in the [[foot]]
 
* [[Specialize|Specialized]] [[orthopedic]] [[Shoe insert|shoes]]
 
* [[Specialize|Specialized]] [[orthopedic]] [[Shoe insert|shoes]]
* Comfortable [[Shoe insert|shoes]] (with the [[Help Menu|help]] of a [[Professional courtesy|professional]] [[Shoe insert|shoe]] fitting device) having:
+
* Comfortable [[Support|supportive]] [[Shoe insert|shoes]] with the following [[Features (pattern recognition)|features]] (with the [[Help Menu|help]] of a [[Professional courtesy|professional]] [[Shoe insert|shoe]] fitting device) [[Help Menu|help]] to [[control]] the [[Motion (physics)|motion]] and lessen the [[Amount of substance|amount]] of [[pressure]] on the [[Ball (anatomy)|ball]] of the [[foot]]:
 
** [[Wide and fast|Wider]] [[toe]] [[box]] allowing [[Spreading activation|spread]] of [[Metatarsal bones|metatarsal heads]]
 
** [[Wide and fast|Wider]] [[toe]] [[box]] allowing [[Spreading activation|spread]] of [[Metatarsal bones|metatarsal heads]]
 
** Low [[Heel|heels]]
 
** Low [[Heel|heels]]
 
** [[Good Friends (Cereal)|Good]] [[arch support]]
 
** [[Good Friends (Cereal)|Good]] [[arch support]]
 +
** [[Stiff pattern|Stiff]] [[soles]]
 +
|-
 +
|Applying [[Ice pack|ice packs]] to the [[sore]] [[foot]] [[Area|areas]] [[Help desk|helps]] in [[Reduction|reducing]] the [[swelling]]
 +
|
 +
* [[Place cell|Place]] a thin towel between [[ice]] and the [[skin]]
 +
* [[Usage analysis|Use]] [[ice]] for 20 [[Minute|minutes]]
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* Wait for at least 40 [[Minute|minutes]] before [[Ice|icing]] again
 
|-
 
|-
 
| colspan="2" |[[Physical therapy]]
 
| colspan="2" |[[Physical therapy]]
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|-
 
|-
 
| colspan="2" |[[Rest cure|Resting]] the [[foot]]
 
| colspan="2" |[[Rest cure|Resting]] the [[foot]]
|-
 
| colspan="2" |Applying [[Ice pack|ice packs]] to the [[sore]] [[foot]] [[Area|areas]] [[Help desk|helps]] in [[Reduction|reducing]] the [[swelling]]
 
 
|-
 
|-
 
| colspan="2" |[[Weight loss]] in [[overweight]] [[patients]] may also [[Help desk|help]]
 
| colspan="2" |[[Weight loss]] in [[overweight]] [[patients]] may also [[Help desk|help]]

Revision as of 03:57, 15 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.B.B.S.[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 proper shoe width, 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, ultrasound-guided interdigital injection of nerve blocking agents such as steroids, local anaesthetics, anti-inflammatory drugs or 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
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:[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]
Anti-inflammatory drugs (orally or injected into the toe area) Shouldn't be used for long-term treatment
Painkillers

References

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  13. 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.
  14. 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.
  15. 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.
  16. 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.
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. 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.
  22. 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.
  23. 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.
  24. 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.
  25. 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.
  26. 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.
  27. 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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