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Mortons Neuroma, How to Treat it?

Musculoskeletal (MSK) disorders affect up to three-fourths of the populations, and are considered among the second highest disability diseases worldwide (Haq et al., 2017; Luan et al., 2018; Sebbag et al., 2019; Woolf, 2015). Up to 53% of musculoskeletal pains occur in the lower extremities (Luan et al., 2018), and foot pain constitutes about 22.3% of the lower extremities MSK disorders (Dutt et al., 2018). The most common causes of lower extremity pain are forefoot neuroma (FFN), plantar fasciitis, Achilles tendinopathy and posterior tibialis tendon dysfunction (Rao et al., 2012). FFN is one of the most common causes of forefoot pain (Latinovic et al., 2006).

FFN is a painful compressive neuropathy of the common interdigital nerve characterised by neuropathic shooting pain over the second or third inter-metatarsal (IM) space and radiating distally to the toes (Munir and Morgan, 2018). Though the exact pathophysiology of FFN is not well established, it is suggested that nerve entrapment between the IM ligament and the plantar foot aspect is the main mechanism of FFN development (Hassouna and Singh, 2005; Valisena et al., 2018). FFN is most prevalent among middle-aged women, especially those wearing high heeled-shoes; tight or ill-fitting shoes; those with foot deformities and those exposed to repetitive trauma, such as certain athletic activities (Di Caprio et al., 2018; Valisena et al., 2018).

Several treatment lines exist for management of FFN (Gougoulias et al., 2019). These treatments are either operative or non-operative interventions. Non-operative treatments include physiotherapy; footwear modifications; activity modification; manipulation and mobilisation of forefoot MSK system; padding and orthotic use (Singh et al., 2005). Interventions of FFN include local corticosteroid injection, radiofrequency ablation, cryoneurolysis and surgical treatment (Singh et al., 2005; Thomas et al., 2009).

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