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Manipulation for mortons neuroma

Discussion in 'General Issues and Discussion Forum' started by NewsBot, Dec 1, 2014.

  1. NewsBot

    NewsBot The Admin that posts the news.


    Members do not see these Ads. Sign Up.
    This clinical trial was just registered:
    Morton's Neuroma: Manipulation Versus Steroid Injection
  2. Admin2

    Admin2 Administrator Staff Member

  3. NewsBot

    NewsBot The Admin that posts the news.

    Manual Therapy In The Management Of A Patient With A Symptomatic Morton’s Neuroma: A Case Report
    Josiah D. Sault et al
    Manual Therapy; Article in Press
  4. NewsBot

    NewsBot The Admin that posts the news.

    Manipulation in the Treatment of Plantar Digital Neuralgia: A Retrospective Study of 38 Cases
    David G. Cashley, BSc Hons, Lynda Cochrane, PhD
    Journal of Chiropractic Medicine; Article in Press
  5. anyone know what manipulation was used ?
  6. Griff

    Griff Moderator

    This taken from the text:

  7. Ian Linane

    Ian Linane Well-Known Member

    I'd be interested to know if they were all diagnosed as actual neuroma presence or not or was the neuritis assumed to arise from a neuroma? Also, if they are actual physical neuroma what the mechanism of action was that reduced the neuritis being caused by the neuroma.

    Another recent paper (2015) is in Manual Therapy:

    Manual therapy in the management of a patient with a symptomatic Morton's neuroma: A case report

    Very detailed, worth a read.
  8. daisyboi

    daisyboi Active Member

    It was a high velcotiy low amplitude technique taking the MTP joint from plantarflexion to dorsiflexion. The technique is described in the full paper.
  9. HansMassage

    HansMassage Active Member

    As in the massage case report listed above I have found that it is a whole body stride distortion that brings on the neuritis. I have not worked with a full neuroma developed in the foot but I have in the hand.
    In the foot I have observed a firing order distortion develops with aa trigger point in the Soleus muscle with a reflex planter contraction holding the third metatarsal in planter flexion as the ankle goes into dorsaflexion at the end of the stride. With the rest of the metatarsals going into extension repeatedly the metatarsal gets locked under the adjoining metatarsals and continues to exert pressure on the nerve when not weight bearing. This happens frequently to myself as well as clients.
    I am prohibited by practice law from using a thrust But with myocardial traction on the trigger point and supported positioning of the forefoot during active planter flexion/dorsaflexion the metatarsal is released and further work can be done to balance the stride.
  10. bob

    bob Active Member

    How does manipulation work for a neuroma?
  11. HansMassage

    HansMassage Active Member

    Correct me if I am wrong but my understanding is that a neuroma is scar tissue developed around a nerve that has been suffering from neuritis. As stated previously I have worked with clients where this developed in the palm of the hands.
    There are massage methods that help integrate such scare tissue to make it more functional but when a nerve is in the scare tissue not just nerve endings such manipulation generally causes more inflammation of the nerve and further scar tissue development. Therefor the manipulation that is effective is indirect to reduce any proximal entrapment of the nerve and muscle or bone pressure on the nerve. Under such non stressed environment them mild stress of normal movement causes fibroclasts to resolve excess scar tissue.
    For example in the hand proximal entrapment occurs at the cervical exit, thoracic outlet [under clavicle] between biracial and fore arm muscles and passing through the elbow and carpel joints. In the foot proximal entrapment can occurs at lumbar and sacral outlets between muscles of the thigh and leg and through the tarsal ankle complex.
    It takes patient communication between the practitioner and client during passive and active movement as to what sensations are felt by experienced palpation and clients perception. Patterns of exacerbation and relief will be discovered which can then be incorporated into a self care plan.
  12. Dieter Fellner

    Dieter Fellner Well-Known Member

    I cannot pretend to know what 'myocardial traction of a trigger point' has to do with MN.

    Morton's neuroma is, more accurately, a perineural fibroma that produces an enlargement of the affected nerve. This is caused (and confirmed with histology) by repetitive micro-trauma. In the advanced case there can be a very substantial fusiform thickening. A key issue, in successful treatment, is accurate diagnosis and a robust differential diagnosis: not always straightforward, with several conditions mimicking and providing for similar symptoms. A key differential is the inter-metatarsal bursitis.

    Many years ago there was an excellent article in the British Journal (I cannot recollect if this was pre-Podiatry Now) demonstrating a manipulation maneuver. I subsequently tried it out - the success was hit & miss, occasionally instantaneous. The problem was in all cases the effect was transient, symptoms recurred. A similar story for cortisone shots. Some patients responding extremely well, others obtained temporary relief, others no effect at all. Mechanical therapy, in the form of addressing the FHL often does provide for a pretty good outcome. In all cases a patient will likely need to take a serious look at their footwear!

    I came to the conclusion, many of the great outcomes, with the essentially non-invasive/non-operative approach is likely the bursitis cases or early MN cases. Advanced cases almost all proceed to surgery for definitive excision, which worked well in my hands with no known cases of adverse complication. Some authorities, notably Dr. Dellon, are fiercely critical of this approach, which nonetheless has stood the test of time. Today we have additional approaches e.g. decompression of the nerve by sectioning of the IML by minimal incision approach. A viable, but still less predictable alternative to excision. I attempted cryosurgery on a small number of cases and was ambivalent, but remained optimistic, about the outcome. There are several other treatment modalities available to the doctor.
  13. NewsBot

    NewsBot The Admin that posts the news.

    Mechanical Diagnosis and Therapy and Morton's Neuroma: A Case Report.
    Post MD
    Physiother Can. 2019 Spring;71(2):130-133.
  14. NewsBot

    NewsBot The Admin that posts the news.


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