Morton's toe pain

　　First, etiology

　　The disease is caused by various factors that compress the plantar total nerve, leading to the disease.

　　Second, pathogenesis

　　1. Wearing high heels is the most common cause of disease. Wearing high heels can increase the load on the front foot, cause excessive hyperextension of the metatarsophalangeal joints, relax the deep transverse ligament between the metatarsal bones of the front foot, collapse the transverse arch, and sink the metatarsal heads 2, 3, and 4, which exactly compress the total plantar nerve located here excessively, causing a plantar total nerve neuroma. In addition, due to the collapse of the transverse arch of the foot and the sinking of the metatarsal heads, the adjacent metatarsal artery near the metatarsal heads can be compressed, causing arterial obstruction, ischemia and hypoxia of the toe nerves, and fibrosis.

　　2. Hallux valgus can cause the transverse arch of the foot to widen and collapse, the metatarsal heads to sink, and cause compression of the interdigital total nerve.

　　3. Trauma such as metatarsal neck fracture, dislocation of the metatarsophalangeal joint, etc., can compress and stimulate the corresponding intermediate total nerve.

　　4. Congenital factors such as flat feet, shallow or disappearance of the transverse arch, congenital shortening of the first metatarsal, can increase the area of pressure on the first metatarsal head, compressing the first and second plantar total nerves and causing symptoms.

　　Morton's toe pain patients mainly complain of pain in the toes and numbness in the corresponding interdigital spaces, which worsens when standing or walking. After rest, taking off the shoes and gently moving the front foot can alleviate the pain. Generally, there are concurrent symptoms of swelling and pain, and infection.

　　It often occurs in women, usually unilateral, and patients mainly complain of pain in the toes and numbness in the corresponding interdigital spaces, which worsens when standing or walking. After rest, taking off the shoes and gently moving the front foot can alleviate the pain. The pain is usually located in the area of the affected metatarsal heads, and the nature of the pain can be dull, piercing, or burning pain. During examination, side-to-side squeezing of the metatarsal heads or squeezing the gaps between the metatarsal heads suspected of having a plantar total nerve neuroma from the dorsal and plantar sides can cause pain and radiate to the adjacent toes. The most commonly affected area is the third interdigital space because it is the lowest, and the plantar total nerve is most easily pinched. The examiner places the thumb and index finger on the dorsal and plantar sides of the suspected neuroma interdigital space, and by pressing back and forth, the neuroma can sometimes be felt sliding back and forth between the metatarsal bones. If there is an enlarged metatarsal interosseous bursa or an abnormally large plantar total nerve neuroma, the interdigital spaces of the affected toes can become wider, and during sensory examination, it can be found that the sensory reduction or disappearance of the affected interdigital spaces.

　　Pay attention not to wear high heels, as high heels can increase the load on the front foot, cause excessive hyperextension of the metatarsophalangeal joints, relax the deep transverse ligament between the metatarsal bones of the front foot, collapse the transverse arch, and sink the metatarsal heads 2, 3, and 4, which exactly compress the total plantar nerve located here excessively, causing a plantar total nerve neuroma. In addition, due to the collapse of the transverse arch of the foot and the sinking of the metatarsal heads, the adjacent metatarsal artery near the metatarsal heads can be compressed, causing arterial obstruction, ischemia and hypoxia of the toe nerves, and fibrosis. Pay attention not to walk for too long and to rest.

　　1. Diagnostic local blockade involves injecting 0.5% lidocaine 1ml into the affected interdigital space. If the pain disappears, it is positive.

　　2. EMG examination is not very helpful in diagnosing this disease.

　　3. X-ray examination can detect changes in foot bone, such as shortening of the first metatarsal, fatigue fracture of the neck of the second metatarsal, etc.

　　The diet of Morton's Predislocation Headache patients should include chrysanthemum brain, as chrysanthemum brain contains not only nutrients such as protein, fat, fiber, and vitamins, but also flavonoids and volatile oils, which have a special fragrance. It is cool and refreshing to eat, and can be stir-fried, served cold, or made into soup. Its stem and leaves are bitter, pungent, and cool, and have the effects of clearing heat and cooling the blood, regulating the middle, and lowering blood pressure when eaten in summer. It can treat constipation, hypertension, headache, and conjunctivitis, among other diseases. Avoid smoking, alcohol, and spicy and刺激性 foods such as scallions, garlic, ginger, Sichuan pepper, chili, and cassia. Avoid greasy foods.

　　1. Conservative Treatment:Wear loose and comfortable flat shoes to allow the metatarsophalangeal joint to fully flex and the toes to fully move. Elevating the metatarsal head can alleviate the symptoms, but the placement must be accurate; too far forward will worsen the pain, and too far back will have no effect. In addition, local corticosteroid hormones such as prednisolone can also alleviate pain.

　　2. Surgical Treatment:If conservative treatment is ineffective, surgical treatment is required. The efficacy of surgical resection of neuromas is relatively certain. Both dorsal incision or plantar incision can be adopted, with the dorsal incision being more common. If a neuroma is present, it can be found at the bifurcation of the common digital nerve into two intrinsic digital nerves at the base of the toe. The proximal resection of the neuroma must be sufficient to avoid scar adhesion between the residual ends and the deep transverse ligament between the metatarsals. Some people prefer the plantar incision, but this incision is prone to damage the intrinsic digital artery of the toe, which should be noted. The loss of skin sensation between the adjacent sides of the toes after the resection of the neuroma does not affect the movement of the toes.