In the first half of the 20th century, the most famous doctor in the United States, regarding problems of the human foot, was Dudley Joy Morton, who “gave” his name to the Morton’s syndrome (neuroma). In fact, the term Morton’s toe (or Greek foot) describes a structural anatomic variant of the foot: the second toe of the foot is longer than the great toe. This means that the second metatarsal bone receives greater loads than it can handle.
In literature, straining of the metatarsals, which leads to the symptoms of pain and inflammation between the toes, is described as metatarsalgia. One of the causes is dropped metatarsals, when one of the bones rests upon the ground with more pressure (the second one is considered more “sensitive”). A secondary stage of the dropped metatarsals is Morton’s syndrome, which occurs when mechanical compression is applied on the interosseous nerve between the long bones.
HIGH RISK GROUPS
Such compression is not only caused by the dropped metatarsals, but generally by any damage causing changes in the structure of the foot and leads to destabilization of the forefoot. As is the case, for example, when the arch is low and the metatarsal bones “trap” or “push” the nerve, and, at the same time, the joint also presses it downwards, resulting in injury and pain between the third and fourth metatarsals. In addition, the shorter first metatarsal in the cases of Mortons’s toes does not offer the necessary stability and support for proper walking, thus, the foot is in a permanent pronation.
Interdigital neuromas appear gradually and are frequent in runners and jumpers, or even those who are involved in team sports at a high level, due to injuries and chronic strain. Middle-aged women are considered the most susceptible ones, mainly because of the shoes they choose – high heels and tight shoes worn for a long time are considered to be particularly “guilty”.
WHICH ARE THE SYMPTOMS?
Patients describe the pain as deep and consistent - more often between the third and fourth toes, but also at the height of the metatarsal heads during walking and standing - and also report a burning, tightening, or cramping sensation. Sometimes it is possible that the symptoms of Morton’s neuroma appear without the symptoms of metatarsalgia, although both symptomatologies are related to the dropped metatarsals.
WHICH IS THE BEST TREATMENT?
Early diagnosis and rapid conservative treatment can prevent surgery. The orthopaedist shall obtain a detailed history, focusing on the patient’s activities. Additionally, the clinical examination shall indicate the general condition of the foot, while an ultrasonography and an MRI shall exclude other causes.
Conservative treatment includes rest, ice, analgesics treatment, use of personalized orthotic insoles for the distribution of loads during walking, and use of spacious shoes with proper heel support.
However, in persistent situations, surgical treatment of the problem is recommended. Transdermal surgery has been performed for the decompression of Morton’s neuroma, as well as other neuromas. Through the minimally invasive technique currently in use, the procedure is easy and fast, and no hospital admission is required. It is performed under local anesthesia. Small incisions on the dorsal surface of the foot replaced the older method of incisions on the plantar surface, which were painful, since long-term irritation during walking was observed. Postoperatively, the patient is soon able to walk, with the help of a special shoe which they should use for approximately 15 days.