Morton's neuroma in afya

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Injection
go in 45-90 deg angle to skin aiming between metatarsal heads on dorsal surface
steroid and lidocaine (0.5mls of each)

benign neuroma affecting the intermetatarsal plantar nerve, 
most commonly in the third inter-metatarsophalangeal space. 
female to male ratio is around 4:1.

''Features''
forefoot pain, most commonly in the third inter-metatarsophalangeal space
worse on walking. May be described as a shooting or burning pain. Patients may feel they have a pebble in their shoe
Mulder's click: one hand tries to hold the neuroma between the finger and thumb. The other hand squeezes the metatarsals together. A click may be heard as the neuroma moves between the metatarsal heads
there may be loss of sensation distally in the toes

Diagnosis is usually clinical although ultrasound may be helpful in confirming the diagnosis

''Management''
avoid high-heels
metatarsal pad
CKS recommends referral if symptoms persist for > 3 months despite footwear modifications and the use of metatarsal pads
orthotists may give the patient a metatarsal dome orthotic
other secondary care options include corticosteroid injection and neurectomy of the involved interdigital nerve and neuroma

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