Advice for possible mortons...

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ok, so here it is........

57 yo female presented with sharp pain sub L 2/3rd met head region.Palpation finds that the spot is distal to the met heads, heading towards the web space. No obvious mass to be felt. Pain stays localised, not radiating into digit. There is some slight webbing of the webspace. No previous trauma to the feet

ONLY aggrivated by walking barefoot on tiles etc. Relieved by footwear and TIGHT shoes.

Passive/active/resisted tests of the area WNL, but mulders click is evident.

Quite a floppy midfoot with mid and rearfoot collapse dynamically

xray -NAD
u/s suggests mortons neuroma

tx- modified Prefab with met dome-failed, repositioned 2 times-failed
modified prefab with cut out-failed
low dye stapping-failed
soft tissue massage of IM space- failed
various forefoot valgus/varus modifications- failed
shank modification to shoe to stope forefoot from doing anything
pt refuses customs

(today)injected with LA- the only thing that has provided relief....but for how long

surgery?...cortosone?



Has anyone had a neuroma with similar posn and aggs/eases?

 

Re: mortons...

Hi Brevis,

Does the patient have any medical conditions? What's the medication history like (if any) ?

You may want to list down a few differential diagnosis. eg, stress #, plantar plate injury, osteoporosis....

Should all conservative management fails, you may want to consider to refer patient to a podiatric surgeon.

I used to have a patient who claimed that after placing the extrinsic met domes below the 3rd/4th met heads, his neuroma seems to be better with much lesser pain.igs:

 

Re: mortons...

Hi Brevis

Is it worth trying to get an MRI scan? One of my patients had long standing pain which was diagnosed as mortons- cortisone only gave short term relief, insoles not successful, then MRI revealed a chondroma .X rays had been NAD.

Regards
Cornmerchant