At the initial stages of the development of the disease is carried out conservative treatment. The first recommendations of the attending physician are: unloading of the feet, periodic use of the metatarsal pads and lifts, wearing shoes with a retrocapital support. The essence of these methods is to reduce the pressure on the nerve trunk. The use of custom-made orthopedic insoles increases the effectiveness of conservative treatment. With their help, it is possible, firstly, to reduce the load on the front area of the foot and restore the state of the transverse arch to normal; secondly, to reduce the pressure of bones and ligaments on the damaged nerve, which allows you to stop the progression of the disease; thirdly, to eliminate the inflammatory process in the nerve fibers and tissues, which significantly reduces or completely eliminates pain; fourthly, to restore the structure of the foot, thereby ensuring the correct gait.
If the pain syndrome is not pronounced, it is possible to use multicomponent compresses with dimexidum, nonsteroidal anti-inflammatory drugs and local anesthetics in combination with muscle relaxants and manual therapy. With insufficient effect, injections of glucocorticosteroids are performed in the interplusar space on the back of the foot, which in half of the cases leads to an improvement in the course of the disease, and in one third of the cases – to complete recovery. If a patient has a deforming arthrosis, it is possible to prescribe chondroprotectors for prophylactic treatment.
In the case of resistance to conservative methods of treatment, patients are offered surgical treatment. In this case, there are several different approaches to the treatment of Morton syndrome surgically.
The most common operation performed under local anesthesia is the removal of the neuroma. Since it is part of the nerve, its hypertrophied and inflamed area is excised. In most cases, this eliminates the pain syndrome, but, as a rule, a small area of unexpressed numbness remains on the foot, which is almost always not felt until the patient touches it. Motor and support functions of the foot do not suffer. The rehabilitation process averages 2-4 weeks, during which the patient is recommended to reduce the load on the foot.
Some surgeons believe that excision of the inflamed area of the nerve as a primary surgical method is too radical. The operation of dissection (release) of the transverse ligament between the metatarsal bones will eliminate the nerve compression. One of the advantages of this method is the absence of sensory disorders. In the event that this operation does not lead to success, excision of the neuroma is possible.
Osteotomy of the 4th metatarsal bone is the least used method of surgical treatment of the pathology under consideration. The essence of the intervention is that due to the displacement of the head of the 4th metatarsal bone after osteotomy (artificial fracture), nerve decompression is achieved. This manipulation is performed under x-ray control through an incision or puncture of the skin, not exceeding 2 mm.
Analysis of the effectiveness of surgical treatment of Morton’s neuroma showed excellent results (complete absence of pain syndrome and other symptoms) in 45% of cases, good results (significant reduction of pain syndrome and almost complete regression of neurological symptoms) – in 32%, in 15% of cases the outcome was satisfactory ( pain syndrome decreased slightly, neurological symptoms persist), in 8% – unsatisfactory (the operation did not bring any improvement). The low effectiveness of surgical interventions is associated with the formation of a true amputation neuroma in the proximal part of the interplusomer nerve….