Interdigital neuritis, also known as Morton's neuroma, results from the entanglement of one or more of the interdigital nerves, which are branches of the medial and lateral plantar nerves.
Over time, a thick neuroma may form that increases the likelihood of chronicity, as the thickened nerve is pinched more easily.
While this condition may occur at any of the interdigital nerves, the most commonly injured is the nerve located between the third and fourth metatarsal.
Although it was originally claimed that the nerve was involved more frequently in this interspace because it receives fibers from both the medial and lateral plantar nerves, this theory has been disproved, as all the interdigital nerves are about the same diameter.
The dorsiflexion of the toes stretches the interdigital nerves during the early propulsive period, allowing them to be compressed beneath the lesser metatarsal heads and their proximal phalanges.
The most popular theory concerning the origin of interdigital neuritis/neuroma until recently was that dorsiflexion of the toes during the propulsive period tied the interdigital nerves against the deep transverse ligament.
- who performed meticulous dissections on 17 fresh, frozen cadavers to assess the relationship between interdigital neuromas and the deep transverse metatarsal ligament during the gait push-off phase.
- Since the authors show that the interdigital neuroma is always distal to the deep transverse ligament, the nerve had to be compressed to the metatarsal head and its proximal phalanx beneath the distal aspect.
- Tightness in the gastrocnemius muscle is a often overlooked cause for the development of an interdigital neuritis.
- Irrespective of the mechanism, comprehensive interdigital neuritis treatment should always include various manual therapies to lengthen a tight gastrocnemius muscle.
- Patients suffering from interdigital neuritis should also be evaluated for the weakness of digital flexors due to their ability to distribute pressure away from the metatarsal heads.
- Because a strong flexor hallucis longus distributes pressure to the great toe away from the central metatarsal heads,5 adequate strength is important in the treatment and prevention of interdigital neuritis in that muscle.
- The patient places the heel on an elevated platform to mobilize an interdigital nerve and then alternately stretches the neck while dorsiflexing the ankle and toes, then flexes the neck while plantarflexing the ankle and toes involved.
- Another manual procedure that is often useful in treating interdigital neuritis is having the patient perform nerve glides after massaging the muscles that traverse the nerve's proximal pathway.
- Even the most troublesome interdigital nerve injuries can respond favorably to conservative care by assessing and correcting the various biomechanical factors affecting the nerves involved.
- An anatomical study of interdigital neuroma of Morton: the relationship between the occurring site and the transverse ligament of metatarsus.
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