Morton’s Neuroma

Abstract

Introduction: In 1876 American surgeon Thomas George Morton first detailed compressive neuropathy of the interdigital nerve of the forefoot. Mortons neuropathy occurs mostly. The condition is generated secondary to repeated pressure or irritation that leads to thickening of the nerve, located in the second or third intermetatarsal space. It is suggested that the use of pointed heel shoes could be a triggering factor for the development of this pathology due to the increased pressure on the forefoot. Objective: to describe the current information related to Mortons neuroma etiology, epidemiology, presentation, diagnosis, management and treatment. Methodology: a total of 39 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 29 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: Morton, neuroma, neuritis, neuralgia, interdigital. Results: it is more frequently present in the female sex, presenting a female:male ratio of 4:1 in some bibliographies and 5:1 in others. The average age at the time of surgery is 50 years old. In 21% of the cases the neuroma is bilateral, in 66% of the cases it is related to the third space, 2% to the fourth and 32% to the second. A study showed that the average diameter of Mortons neuroma was 4.1 mm in the asymptomatic staff versus 5.3 mm in the symptomatic group. Conclusions: This condition is certainly not a neuroma as it is a degenerative rather than neoplastic condition due to fibrosis of the digital nerve. The diagnosis is primarily clinical, where there may be altered sensation and a dorsal bulge. Examinations, investigations and non-surgical treatment are the same as those used in a primary neuroma. The use of orthoses and footwear modifications is indicated for conservative treatment. For surgical treatment, dorsal and plantar approaches are used, each with their advantages and disadvantages. The dorsal incision should be extended proximally to observe the residual limb, however sometimes exposure becomes difficult. The plantar approach provides better exposure for the nerve to be easily identified and resected, however the presence of painful scarring is notable. Other complications that may occur are atrophy, recurrence and chronic pain. KEY WORDS: Morton, neuroma, neuritis, neuritis, neuralgia, interdigital.