(OANDP-L)Morton's Neuroma
Richard Ziegeler
Description
Collection
Title:
(OANDP-L)Morton's Neuroma
Creator:
Richard Ziegeler
Date:
8/20/2003
Text:
Well, it seems that there is nothing new under the sun! The treatment for this painful condition is still as I have been doing. All responses basically indicated that a met dome on some kind of satisfactory substrate is as it should be.
I have found that sometimes this approach is insufficient and the patient is off to a surgeon. After that I don't hear of them (until their neuroma redevelops!)
Sincere thanks to all members of the list who helped out and showed the value of this forum. This kind of stuff beats the pants off gripes about Ossur!
Herewith the responses, if nothing else, a great refresher. Richard Ziegeler (P&O)
======================================
All the one's I did I made an hallux extension of the 1/8 plastic substrate arch support all the way to end of toe. This is to limit D/F of the hallux. No one as returned and no complaints from DPM either so I guess it works okay.
=============================
I treat this Dx several times a week. I like to use foot imprinter to take wt bearing print. This helps identify pressure area beneath MTP joint. I make a thin leather sulcus length insole with a PQ met pad placed just
proximal to the MTP joint. This insert fits in most shoes and is very well received by most patients.
===================================
First, you must make sure that the shoes are the proper length and width.If the shoes are too small you will be fighting and uphill battle. Add a met pad 1/4 inch proximal to the affected site. Most neuroma symptoms are
relieved with these two procedures.
=================================
Springlite foot plates from Otto Bock
=============================
we use a carbon mortons extension foot plate NRG or Springlite. and usually accompany this with some sort of dual density or cork orthotic full length with a met pad. Some insurance companies will not pay for the mortons extension only, but will pay for the orthotic and use the carbon segment code L2something. I hope this helps.
=============================
I have found that an aggressive metatarsal arch support and possibly even a slight metatarsal bar built right into/onto a custom molded foot orthosis is normally enough to take care of the problem. If it relieves the pain, then the inflammation should also dissipate and eventually disappear
=============================
.........a custom insole with a beautiful met dome should do the trick ..........as you want to try and spread the met heads to reduce the compression of the nerves between the metatarsals and then everything should be OK(or something like that!)
=================================
Two component silicon mold from USA 'Pediplast or similar from Ottobock can be molded and put below toes. Or Toe Crest made by Apex fits in sulcus area on plantar aspect with a sling over 2nd and 3rd toe.
=================================
Hapad has a self adhesive neuroma pad with instruction on how to place it. I use it as a tool to find out if a pad will alleviate the patient's pain. These pads tend to move around so, once I determine the pad will work, I make a permanent pad, incorporating it into a shoes
innersole or an FO
==============================
I have added a met. pad behind met. heads of affected area. The thing that will help the patient the most is wide toebox shoes so there isn't any pressure on sides of toes. By the shoes being too tight it squeezes the toes together and causes pain. For a test just squeeze the forefoot together as the shoes would be doing and this should cause the patient pain. They will see where they would benefit from wider toebox shoes
=============================
the best way to treat a morton's neuroma orthopedically would be an arch support with a met pad or met bar. Neuromas are usually caused by the collapse of
the metatarsal arch which causes the met heads to rub on the nerve (usually located between the 3&4 toe but sometimes between 4&5) which causes a capsule
around the nerve, i.e. the neuroma. reducing the pressure on the met heads and recreating the metatarsal arch ususally helps. Neuromas can be surgically removed, however, if the rubbing on th nerve continues after surgery, it can come back.
I have found that sometimes this approach is insufficient and the patient is off to a surgeon. After that I don't hear of them (until their neuroma redevelops!)
Sincere thanks to all members of the list who helped out and showed the value of this forum. This kind of stuff beats the pants off gripes about Ossur!
Herewith the responses, if nothing else, a great refresher. Richard Ziegeler (P&O)
======================================
All the one's I did I made an hallux extension of the 1/8 plastic substrate arch support all the way to end of toe. This is to limit D/F of the hallux. No one as returned and no complaints from DPM either so I guess it works okay.
=============================
I treat this Dx several times a week. I like to use foot imprinter to take wt bearing print. This helps identify pressure area beneath MTP joint. I make a thin leather sulcus length insole with a PQ met pad placed just
proximal to the MTP joint. This insert fits in most shoes and is very well received by most patients.
===================================
First, you must make sure that the shoes are the proper length and width.If the shoes are too small you will be fighting and uphill battle. Add a met pad 1/4 inch proximal to the affected site. Most neuroma symptoms are
relieved with these two procedures.
=================================
Springlite foot plates from Otto Bock
=============================
we use a carbon mortons extension foot plate NRG or Springlite. and usually accompany this with some sort of dual density or cork orthotic full length with a met pad. Some insurance companies will not pay for the mortons extension only, but will pay for the orthotic and use the carbon segment code L2something. I hope this helps.
=============================
I have found that an aggressive metatarsal arch support and possibly even a slight metatarsal bar built right into/onto a custom molded foot orthosis is normally enough to take care of the problem. If it relieves the pain, then the inflammation should also dissipate and eventually disappear
=============================
.........a custom insole with a beautiful met dome should do the trick ..........as you want to try and spread the met heads to reduce the compression of the nerves between the metatarsals and then everything should be OK(or something like that!)
=================================
Two component silicon mold from USA 'Pediplast or similar from Ottobock can be molded and put below toes. Or Toe Crest made by Apex fits in sulcus area on plantar aspect with a sling over 2nd and 3rd toe.
=================================
Hapad has a self adhesive neuroma pad with instruction on how to place it. I use it as a tool to find out if a pad will alleviate the patient's pain. These pads tend to move around so, once I determine the pad will work, I make a permanent pad, incorporating it into a shoes
innersole or an FO
==============================
I have added a met. pad behind met. heads of affected area. The thing that will help the patient the most is wide toebox shoes so there isn't any pressure on sides of toes. By the shoes being too tight it squeezes the toes together and causes pain. For a test just squeeze the forefoot together as the shoes would be doing and this should cause the patient pain. They will see where they would benefit from wider toebox shoes
=============================
the best way to treat a morton's neuroma orthopedically would be an arch support with a met pad or met bar. Neuromas are usually caused by the collapse of
the metatarsal arch which causes the met heads to rub on the nerve (usually located between the 3&4 toe but sometimes between 4&5) which causes a capsule
around the nerve, i.e. the neuroma. reducing the pressure on the met heads and recreating the metatarsal arch ususally helps. Neuromas can be surgically removed, however, if the rubbing on th nerve continues after surgery, it can come back.
Citation
Richard Ziegeler, “(OANDP-L)Morton's Neuroma,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/221526.
