Diagnosis and Treatment of Morton Neuroma, Plantar Fasciitis, and Achilles Tendinopathy
Dec 19, 2023
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Discover the diagnosis and treatment of Morton neuroma, plantar fasciitis, and Achilles tendinopathy. Learn about diagnostic tests for Morton's neuroma, the use of eccentric exercises for Achilles tendonitis, and the risk factors associated with Achilles tendonitis. Explore novel treatments like platelet-rich plasma and extra-corporeal shockwave therapy for foot disorders.
Morton neuroma is diagnosed through physical examination tests like the thumb index squeeze test and Mulders sign, and can be effectively managed without surgery through options like wide toe box shoes and corticosteroid injections.
Plantar fasciitis involves heel pain in the inner aspect of the plantar heel, and can be treated with a home stretching protocol, arch support orthotics, and avoiding exacerbating activities.
Deep dives
Common Painful Foot and Ankle Conditions
The podcast discusses three common foot and ankle conditions: Morton's neuroma, plantar fasciitis, and Achilles tendonitis. These conditions were chosen because they are prevalent and can be managed without surgery. Morton's neuroma is characterized by pain in the ball of the foot, often between the third and fourth metatarsals. Diagnostic criteria include tests like the thumb index squeeze test and Mulders sign. Treatment options include wide toe box shoes, injections for pain relief, and over-the-counter orthotic inserts. Plantar fasciitis involves heel pain, particularly in the inner aspect of the plantar heel. The primary treatment involves a home stretching protocol and the use of arch support orthotics. Achilles tendonitis affects the mid portion of the Achilles tendon and is evaluated through physical examination tests like the painful arc sign. Eccentric exercises, where the calf muscles contract while lengthening, have shown benefit for this condition. Fluoroquinolones have a slight association with Achilles tendonitis, but the absolute risk is small. Platelet-rich plasma (PRP) and extracorporeal shockwave therapy (ESWT) are two novel treatment options, although the evidence is limited. Non-surgical management and patience are key in treating these common foot disorders.
Morton's Neuroma: Causes and Management
Morton's neuroma is characterized by fibrosis or scarring of the nerve, leading to pain in the ball of the foot. The condition is diagnosed through physical examination tests like the thumb index squeeze test and Mulders sign. Treatment options include avoiding inciting activities, wearing wide toe box shoes, corticosteroid injections for pain relief, and using over-the-counter orthotic inserts. Custom made orthotics are not necessarily superior and are more expensive. Non-operative management is often effective for reducing symptoms without the need for surgical consultation.
Plantar Fasciitis and Achilles Tendonitis: Causes and Treatment
Plantar fasciitis involves pain in the bottom of the heel, particularly in the medial or inner aspect of the plantar heel. Treatment options include a home stretching protocol, arch support orthotics, and avoiding exacerbating activities. Eccentric exercises, where the calf muscles contract while lengthening, have shown benefit for Achilles tendonitis. Flat feet are not necessarily a problem with the plantar fascia, and high arch feet can also develop plantar fasciitis. Fluoroquinolones only slightly increase the relative risk of Achilles injury. Platelet-rich plasma (PRP) and extracorporeal shockwave therapy (ESWT) are treatment options, although their effectiveness is still under investigation. It is important for patients to have realistic expectations, as these conditions often require time and patience for full recovery.
Most people will experience a painful foot or ankle condition at some point in their lives. JAMA Associate Editor David Simel, MD, MHS, discusses diagnosis and treatment of Morton neuroma, plantar fasciitis, and Achilles tendinopathy with Minton Truitt Cooper, MD, of the University of Virginia, Charlottesville. Related Content: