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Neuritis – Treatment in Dubai

June 10, 2017 by Michelle0

Introduction
An Intermetatarsal (Mortons) Neuroma is a thickening of nerve sheath/tissue located between the metatarsal bones of the foot. Most commonly located between the 3rd and 4th interspace as this is where the Medial and Lateral Plantar Nerves combine making it an already larger nerve. This location is known as Mortons Neuroma.
Etiology
Causes of developing an Intermetatarsal Neuroma include:
€¢ Compression and irritation of the nerve
€¢ Ill fitting footwear €“ Shoes that are too small, have a tight/narrow toe box or high heel shoes that increase pressure onto the metatarsal heads
€¢ Foot deformities €“ Bunions, flat feet, over pronation, hammer digits, collapsed transverse arches will all increase the susceptibility of compression to the nerve sheath and thus may develop a neuroma.
€¢ Sporting Activities €“ Sports such as; running, tennis, ballet and Irish dancing require extra load/time on the ball€™s of the feet
Symptoms
€¢ Localized pain intermetatarsally that can be sharp or dull
€¢ Tingling, burning or numbness may be present
€¢ Symptoms can radiate along the foot distally or/and proximally
€¢ The associated digits may be numb
€¢ Pain usually increases with wearing footwear
€¢ Pain can increase with palpation of the metatarsal interspace
€¢ Pain can increase with testing €œMulders Sign€ and a €˜click€™ may be heard

How a Podiatrist can help?
€¢ Diagnosing and treating any occurring foot deformities with orthoses devices
€¢ Pain can increase with testing €œMulders Sign€ and a €˜click€™ may be heard
€¢ Applying a metatarsal arch pad to footwear to reduce the compression forces on the nerve
€¢ Advising activity modification €“ Rest and icing the area
€¢ Non Steroidal Anti-inflammatory drugs can help minimise pain and inflammation
€¢ Footwear advise €“ wear shoes with wide toe boxes and avoid high heel or narrow shoes
€¢ An X-ray may need to be taken to rule out differential diagnosis such as stress fractures
€¢ Doctor or Orthopaedic referral for corticosteroid injection or reconstructing bone alignment through surgery

Sesamoiditis & Dubai Podiatry Centre
Details
Written by Maureen Duffy B.A.Hons.,A.C.I.M.,U.K.
What is sesamoiditis?
Sesamoiditis is an inflammatory condition affecting the periosteum of the seasmoid bones.
The tibular and fibular sesamoid bones are two well defined bones located on the plantar surface of the first metatarsal head and lie within the flexor hallucis brevis and longus tendons which are responsible for moving the big toe (hallux).
Sesamoids are present in approximately 85% of the population. They appear in the third fetal month of development and remain as cartilage until about 8-10 years of age when they ossify (become bones).

The purpose of the sesamoids are to:
55 Act as a fulcrum for the FHB tendon by increasing the mechanical force of the tendons
56 Serve to protect the FHL tendon
57 Reduce friction
58 Absorb shock at the forefoot during loading by redistributing ground reaction forces thus protecting the metatarsal head.€
Just over 1% of all running injuries involve the sesamoids with 40% of these being stress fractures and 30% diagnosed as sesamoiditis. There are different types of injury to the sesamoids – find out more here.
The main causes of sesamoiditis include:
26 Increase in activity
27 Sports involving weight onto the forefoot e.g. Jumping, Ballet, Irish Dancing
28 High heel shoes
29 Shoes with little cushioning
30 Foot posture: Pes Cavus, plantar flexed first rays, hyperextended hallux and pes planus or flat feet.
31 Relative lengths of the 1st and 2nd metatarsals.
Examination & Diagnosis
There may be a history of gradual onset of pain (chronic) localized to the plantar surface of the first metatarsal head, or an initial trauma (acute) can offset symptoms. Pain on palpation on either of the sesamoid bones which can be distinguished by dorsiflexing and plantarflexing the hallux. Movement of the joint can increase pain. While swelling and erythema are often present thus limiting the first metatarsal/phalange joint range of motion. The favouring of one foot with a limp can be present.
How a Podiatrist can help?
Initial modification of your exercise regime may be advised, to allow the sesamoids to recover. Conservative treatment includes: rest, ice, anti-inflammatory medication and flexibility exercises.

We will assess the your foot alignment, identify any foot anomalies and perform a gait analysis. Custom orthotics may be advised to accommodate any foot issues causing too much load through the forefoot, offloading the sesamoids, redistributing the forces across the foot and preventing future injury. This also gives the area time to heal. We may also modifying your footwear to provide extra support and cushioning and where possible, advise limiting or avoiding high heels.
If you have any concerns about your feet or are experiencing pain, contact the foot experts at Dubai Podiatry Centre for friendly and detailed professional advice, treatment and care. +971 4 3435390


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