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JANUARY | FEBRUARY 2017

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88 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 1 7 technique SCIENCE OF NERVES Putting the Squeeze on Morton's Neuroma Treatment for Nerve Compression By Whitney Lowe One of the more common nerve entrapment problems affecting the lower extremity is Morton's neuroma. The term neuroma is a bit of a misnomer because this condition generally does not involve a true neuroma, which is essentially a nerve cyst or tumor, and instead involves nerve impingement in the forefoot region. In most cases, it is strictly a nerve compression syndrome, although the problem can be caused by fi brosis of the tissue around the nerve. This condition is also sometimes called Morton's metatarsalgia (which means metatarsal pain) or interdigital neuritis. Morton's neuroma is a nerve compression problem in which massage can play a signifi cant role in reducing symptoms. ANATOMICAL BACKGROUND This nerve compression problem is sometimes confused with Morton's foot, which is completely different. Morton's foot is a structural classifi cation of the foot in which the second metatarsal is longer than the fi rst. This makes the second toe appear longer than the hallux when looking at the foot. However, Morton's foot does not have anything to do with the nerve compression that occurs with Morton's neuroma. Sensory signals for the forefoot and toes are supplied by the plantar digital nerves. The digital nerves are the terminal extension of the medial and lateral plantar nerves, which in turn are divisions of the tibial branch of the sciatic nerve (Image 1). A closer look at the pathway of these plantar digital nerves indicates why they are susceptible to compression between the metatarsal heads in this condition. The metatarsal heads are bound together by the deep and superfi cial transverse metatarsal ligaments, which create a small opening or tunnel between the metatarsal heads. The plantar digital nerve branches course through these small tunnels between the metatarsal heads (Image 2). 1 Medial and lateral plantar nerves. Image is from 3D4Medical's Complete Anatomy application. 1 Medial and lateral plantar nerves. Image is from 3D4Medical's Complete Anatomy application. Lateral plantar nerve Medial plantar nerve 2 Deep and superfi cial transverse metatarsal ligaments. Image is from 3D4Medical's Complete Anatomy application. Plantar digital nerve 2 Deep and superfi cial transverse metatarsal ligaments. Image is from 3D4Medical's Plantar digital nerve Deep transverse metatarsal ligament Superfi cial transverse metatarsal ligament

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