Fascial Manipulation Technique in the Conservative Management of Morton’s Syndrome: A Pilot Study

Abstract

Background and Objective: Morton’s syndrome (MS) is a common cause of neuropathic chronic forefoot pain, characterised by the development of a swelling of the common digital plantar nerve, whose aetiology is not fully known. There is currently no gold standard of treatment; nonoperative management commonly involves manual therapies, orthoses therapy and infiltrative techniques, while surgery is indicated after failure of conservative measures. The present preliminary study prospectively evaluates patients affected by MS treated by Fascial Manipulation technique (FM), a noninvasive manual therapy, focused on the release of the deep fascia, reducing its stiffness. Materials and Methods: Patients with clinical and sonographic diagnosis of MS with at least a 4-month history of neuropathic symptoms underwent a cycle of three weekly FM sessions. Clinical follow-up, including VAS and AOFAS scores, was performed 21 days (T1) and 3 months (T2) after treatment. Results: Nine patients, among 28 recruited initially, completed the manual therapy sessions and relative follow-up points. This noninvasive pain treatment led to significant improvement of VAS (p = 0.0034) and AOFAS scores (p = 0.0240) at the first follow-up (T1). At 3-month follow-up (T2), both scores decreased slightly, remaining however superior to the pre-treatment values. Only VAS was still significant (p = 0.0184). Conclusions: Despite the small size of the case series, this pilot study is unique in supporting Fascial Manipulation in the nonoperative treatment of MS. Further studies are needed with a large cohort of gender balanced patients to confirm the encouraging results obtained.

Effects of Metatarsal Foot Orthosis on Biomechanical 3D Ground Reaction Force in Individuals with Morton Foot Syndrome during Gait: A Cross-Sectional Study

“…Although the primary etiology of MFS is not fully understood and remains controversial [ 5 , 6 ], it is a hereditary syndrome characterized by a short first metatarsal and posterior displacement of the sesamoid bones (sometimes leading to inflammation: sesamoiditis) [ 7 ]. Other theories have assumed replacement vascular or traumatic injuries as a cause of MFS [ 8 ].…”

“…The MFS is known to have a negative effect on biomechanical factors, such as pressure distribution and ground reaction force (GRF), in the Morton’s foot area during gait [ 3 ]. In addition, the syndrome usually causes severe pain and burning sensation in the intermetatarsal bones, which may spread to the adjacent toes, dorsum of the foot, and hindfoot [ 8 ]. MFS is exacerbated by walking using narrow shoes, and it is often associated with paresthesia or dysesthesia in the affected nerve region, known as neuroma [ 9 , 10 ].…”

Infiltrative Type I Collagen in the Treatment of Morton’s Neuroma: A Mini-Series

“…However, the "lesion" has perineural fibrosis, in which it does not have any pre-neoplastic or neoplastic condition [6]. The MN pathology presents with a broad spectrum of symptoms, including paresthesia, metatarsalgia and stabbing pain in the metatarsal plantar region [7]. The symptoms could also involve the nearby toes and other parts of the foot [4].…”

Plantar and dorsal approaches for excision of morton’s neuroma: a comparison study

“…Conservative management is recommended at first, including lifestyle modifications (avoidance of tightfitting shoes, orthotics, and local infiltrations of corticosteroids), as well as mobilisation and manipulation techniques. Surgical intervention is recommended after the failure of conservative therapy [8]. Neurectomy is a standard operating procedure in the treatment of Morton's neuroma, although many others were reported [9].…”