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Lewis G. Maharam, MD Thursday, 16 May 2013 10:10 TWEET COMMENTS 0

Feet Don't Fail Me Now - Page 3

Morton’s Foot

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The Neuroma

In 1927, a physician named Dudley Joy Morton first described a foot where the second toe is longer than the big toe. Most folks have it the other way around, but 30 percent of the population has the foot Morton described. Actually, people with Morton’s foot have a normal-size big toe but a shorter first metatarsal than usual, and therefore the big toe starts farther back.

This is important for runners because we get our power to move forward off the base of that first metatarsal. Because the Morton’s metatarsal is shorter, the foot is prone to overpronation and thereby stresses the bone. The overpronation can also inflame a nerve that lies between the second and third metatarsals; inflammation of the nerve is called neuroma.

Orthotics can help both conditions by reducing the stress. They must run the full length of the foot and be flexible. The neuroma may need a cortisone injection. Rarely, surgeons remove the nerve if it remains painful; note, however, that with removal goes the ability to feel what your foot is doing. I have never had a case where proper orthotic control and injection did not make the neuroma pain go away, so in my experience, surgery is unnecessary.

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Quick Guide: Morton’s Neuroma

Symptoms: Inflammation and pain between third and fourth toes.

How it occurred: Chronic overpronation or supination.

What the doctor may do: Physical examination. Gait analysis.

Likely treatment: Full-length orthotic or orthotic adjustment. Cortisone injection. Platelet-Rich Plasma (PRP) injection. In extreme cases, surgery to remove swollen nerve.



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