Morton's neuroma

There is no single clear cause. Several factors reduce the interdigital space and consequently produce neuralgia symptoms:

• Repeated injuries of the metatarsophalangeal joints
• Inflammation and enlargement of an interdigital bursa
• Synovitis of the metatarsophalangeal joints caused by excessive loading (flatfoot, sport)
• Lateral deviation of the toes caused by tight, narrow footwear or a forefoot deformity, such as hammer toe
• Metatarsal fracture changing the alignment of the bones relative to one another
• Thickening and laxity of ligaments around the metatarsophalangeal joints

Depending on clinical and imaging assessment, including ultrasound and MRI, treatment is divided into conservative and surgical options.
Conservative treatment includes:

• Stopping sports or activities that cause repeated microtrauma
• Soft, cushioning insoles under the forefoot
• Comfortable footwear with a wide toe box
• Local physical treatments – ultrasound, laser therapy and iontophoresis
• A local steroid injection has a short-lived effect
• Local injection of 30% ethyl alcohol under ultrasound guidance
• Oral medicines such as vitamin B6, non-steroidal anti-inflammatory drugs and serotonin-reuptake inhibitors

In most patients (60%), symptoms recur after initially subsiding. Surgery is then indicated, involving removal of the enlarged bursa, ligaments and synovium compressing the nerve, or removal of the neuroma itself.

After surgery, patients wear postoperative footwear for 2 weeks. They then begin using their own shoes, which must be somewhat roomier and have a flat sole. Sport and heeled shoes are possible 3 months after surgery.

Rehabilitation is an important element supporting rapid recovery after Morton’s neuroma surgery. To be effective, it should be based on the following principles:

• the patient’s condition should be assessed
• Individual recommendations should be prepared for postoperative treatment
• therapy should be adapted to the patient’s abilities

Individual exercises with the patient aim to:

• improve proprioception
• improve neuromuscular coordination
• Reduction of swelling (soft-tissue work, lymphatic massage, kinesiotaping)
• correct gait and faulty movement habits
• physiotherapy 

In foot surgery, ensuring a pain-free operation and minimising postoperative pain have always been major challenges.

It is commonly believed that recovery after foot surgery, especially hallux surgery, is very painful.

There are many options for anaesthesia during procedures on the foot.

Modern anaesthesiology aims, wherever possible, to use regional anaesthesia techniques – from central blocks such as spinal and epidural anaesthesia, commonly known as lumbar anaesthesia, to peripheral nerve blocks at various levels performed under ultrasound guidance, especially when operating on one foot.

The possibility of using a particular type of anaesthesia depends mainly on the extent of surgery and any coexisting conditions.

The final choice of anaesthesia is agreed with the patient during the preoperative assessment interview.

Using ultrasound in anaesthesiology to perform peripheral nerve blocks has enabled highly precise regional anaesthesia.

Our many years of experience have changed our perioperative approach, both to anaesthesia itself and to the postoperative period.

For foot surgery, peripheral nerve anaesthesia, known as an ankle block, means injecting a local anaesthetic around the nerves at the appropriate level.

These anaesthetics are highly precise because the nerves responsible for pain sensation are clearly visible on ultrasound and medication delivery is fully controlled.

This can substantially reduce or even eliminate the need for pain medication early after surgery.

For many patients, one of the most important advantages is that sensation above the knee is preserved in the operated leg and, most importantly, lumbar anaesthesia is avoided, which patients do not always accept.

Another important advantage is that walking can begin very soon after the procedure.

During the postoperative period, administering pain medication at regular intervals under ultrasound guidance around the nerves responsible for pain enables patients to pass through this period as comfortably and painlessly as possible.