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Uploaded byMd. Nayeem Hasan
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Motorn's neuroma

Morton's neuroma is a common foot condition that causes pain in the ball of the foot, usually between the third and fourth toes. It occurs when a nerve in the foot is compressed, causing pain, numbness, and tingling. Symptoms include pain that gets worse with walking and is relieved by removing shoes. Treatments may include shoe inserts, steroid injections, and surgery. The condition is often caused by wearing narrow, tight shoes that squeeze the toes together.

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MORTON’S NEUROMA
Morton’s neuroma Introduction of Morton’s neuroma: o Morton’s neuroma (also known as Morton’s metatarsalgia, Morton’s neuralgia, plantar neuroma or intermetatarsal neuroma). o In 1876, Morton describe a condition of pinching of the leteral plantar nerve in the fourth and fifth metatarsal heads of the foot.
Cont……. Morton’s neuroma is a common problem,with neuralgia affecting a single distal metatarsal inter- spece,usally the third( affecting the third and fourth toes) sometimes the second (affecting the second and third toes),rearly others.
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Cont…….. Clinical Features:  Patient complans of pain in the region of the third and fourth metatarsals head.By walking pain increases and decrease by rest.with the sensation of walking on a pabble in the shoe, or the sock being rucked –up undre the ball of the foot. The pain is worse in tight footwear and often has to be relife by removing the footwear and messaging the foot.
Cont…… In morton’s metatarsalgia the pain is typically reproduced by laterally compressing the forefoot.
Cont…………Activities that load the forefoot (runing,jumping,dancing)exacrbat e the condition,Which often consists of severe forefoot pain and then a reluctance to weight bear. Mulder ‘s click When neuroma is squeezed between the metatarsal heads a click is felt. This is common in Women and is usally unilateral.
Cont…….  Radiograph: Pain X-ray,MRI of the fore foot especially the AP view is recommended as a routine and helps to rule out any bony problems.
Cont…….. Syndrome of morton’s neuroma: o This is essentially an entrapment or compression syndrome affecting one of the digital nerve. o but secondary thickening of the nerve creates the impression of a neuroma. o An associated bursa o Occupy a restricted space between the distal metatarsals,and are pinched, especially if footwere also laterally compresses the avaible space.
Cont…… Causes of morton’s neuroma: Morton's neuroma are women who wear high- heeled or narrow shoes. Conditions and situations that can cause the bones to rub against a nerve include: High-heeled shoes -
Cont…… o High-arched feet. o Flat feet o Hammer toe o Some high-impact sporting activities o Injuries
Cont…….. Treatment of morton’s neuroma: A stape- wise treatment programme is advisable- Simple offloading of the metatarsal heads by using a metatarsal dome insole and wider fitting shoes may help. lf symptoms don’t improve with these ,measures then a steroid injection into the interspace will bring about lasting relife in about 50 percent of cases.
Cont…..
Cont………  Surgical intervention is often successful then the nerve should be released by dividing the tight transvers intermetatarsal ligament,this can be done through either a dorsal longitudinal or planter incision, most surgeons will also excise the thickened portion of the nerve.This successful in about 90 percent of patient remaning 10 percent will continue to experiencevarying degrees of discomfort.
Cont…….. Tarsal tunnel syndrome: Pain and disturbance in the medial part of the forefoot,unrelated to weight bearing, may be due to compressionof the posterior tibial nerve behind and below the medial nerve behind and below the medial malleolus.Sometimes this is due to a space –occupying lesion. ( e.g. ganglion,hemangioma or varicosity).
Cont……  This diagnosis is difficult to establish but nerve conduction studies may show slowing of motor or sensory conduction.
Cont……….. Treatment: To decompress the nerve it is exposed behind the medial malleolus and followed into the sole, sometimes it is trapped by the belly of adductor hallucis arising more proximally than usual. Summary: Overview Symptoms & Causes Diagonosis & Treatment
Cont………. Reference:  http://www.mayoclinic.org/diseases- conditions/mortons-neuroma/more-about/in- depth/ssc-20202645  TEXT BOOK: Essentials of Orthopedics ( Second Edition) by- john Ebnezar  TEXT BOOK: Apley’s System of Orthopaedics and Fractures (Ninth Edition) by Louis Solomon— david Warwick selvadurai Nayagam.
Motorn's neuroma