Morton Plantar Headache
Introduction
Introduction to Morton's headache Morton's headache, also known as Morton's disease, refers to the clinical signs and symptoms caused by the compression of the common toe base between the two metatarsal bones. In 1845, Durfacher first described the clinical manifestations of the total neuroma. However, it was not accepted by everyone at that time. Until 1867, Morton reported 15 cases and proposed the cause of this clinical manifestation and the method of surgical treatment, which attracted peoples attention. Morton has a headache. The disease occurs at most in the 3rd and 4th toe gaps, followed by the 2nd and 3rd toe gaps, and other toe gaps are rare. basic knowledge The proportion of illness: 0.011% - 0.013% Susceptible people: more than women Mode of infection: non-infectious Complications: bacterial infection
Cause
Morton headache headache cause
(1) Causes of the disease
The disease is caused by a variety of factors causing the total nerve base of the toe.
(two) pathogenesis
1. Wearing high heels is the most common cause of the disease. Wearing high heels can increase the weight of the forefoot, excessive extension of the metatarsophalangeal joint, relaxation of the deep transverse ligament between the forefoot and the tibia, collapse of the crossbow, and sinking of the 2nd, 3rd, and 4th bones. Excessive compression of the total base of the toe base located here, resulting in total toe-bottom neuroma. In addition, due to the collapse of the transverse arch, the sinking of the humeral head can compress the toe of the humeral head adjacent to the total base of the toe. Arteries, causing arterial occlusion, toe nerve ischemia, hypoxia, fibrosis.
2. The valgus can cause the transverse arch to widen, collapse, and the humeral head sink, causing total nerve compression between the toes.
3. Traumatic humeral neck fracture, dislocation of the metatarsophalangeal joint, etc. can be stimulated to stimulate the corresponding intermediate nerve.
4. Congenital factors such as flat feet, flat bows become shallow or disappear, congenital first metatarsal shortening, can increase the pressure area of the first metatarsal head, compression of the first and second toe total nerves produce symptoms.
Prevention
Morton headache prevention
Be careful not to wear high heels, because high heels can increase the weight of the forefoot, the metatarsophalangeal joints are excessively stretched, the deep transverse ligaments between the forefoot and the tibia are loose, the crossbows collapse, and the bones of the 2nd, 3rd, and 4th are sinking, just right here. The total nerve of the base of the toe is excessively compressed, resulting in a total neuroma. In addition, due to the collapse of the transverse arch, the sinking of the humeral head can compress the common toe artery adjacent to the common base of the humerus, causing obstruction of the artery, ischemia, hypoxia, and fibrosis of the toe. Be careful not to take too long to rest when you walk.
Complication
Morton headache complications Complications bacterial infection
Generally, it is accompanied by pain and infection.
Symptom
Morton headache symptoms common symptoms dull pain toe gap numbness
More common in women, often unilateral onset, the patient complained of the pain of the toes and the corresponding toe gap numbness, standing, aggravated when walking, take off the shoes after the break, gently move the forefoot can be relieved, the painful part is usually in the affected tibia In the head area, the nature of the pain may be dull pain, tingling or burning pain. When inspecting, laterally squeezing the humeral heads, or squeezing the adjacent humeral head space from the dorsal and temporal sides of the suspected total sacral neuroma. It can produce pain and radiate to the adjacent two toes. The most frequently affected part is the third toe gap. Because the position is the lowest here, the total nerve of the toe is most easily squeezed. The examiner uses the thumb and forefinger respectively. On the dorsal and temporal sides of the toe-ankle space where the neuroma is suspected, the anterior and posterior compression may sometimes touch the neuroma to slide back and forth across the intersacral ligament, if there is an enlarged intercondylar sac or an abnormally enlarged toe. In the total neuroma, the two toe gaps can be widened, and the feeling of the affected toe gap can be found to decrease or disappear.
Examine
Morton's headache check
1. Diagnostic partial closure is injected into the affected toe gap with 1 ml of 0.5% lidocaine, and is positive if the pain disappears.
2. EMG examination does not help much in diagnosing this disease.
3. X-ray examination can find bone changes in the foot, such as the first metatarsal shortening, the second metatarsal neck fatigue fracture.
Diagnosis
Morton headache diagnosis and identification
diagnosis
Diagnosis can be established based on medical history, clinical manifestations, and local diagnostic closure. X-ray examination can exclude bone changes.
Differential diagnosis
1. sacral skull rickets, also known as Fieberg disease, occurs in adolescents, more common in women, often occurs in the second metatarsal head, manifested as pain in the affected metatarsophalangeal joints, increased when standing and walking, tenderness at the humeral head, back Lateral soft tissue swelling, acute symptoms can be reduced and the humeral head is enlarged, and the metatarsophalangeal joint activity is limited. X-ray films can be characterized as irregular and brightening of the distal end of the affected humeral epiphysis. The humeral head is crescent-shaped, concave and dense. Increased and has some small rounded translucent areas.
2. The spasm of the metatarsophalangeal joint can also be expressed as pain at the metatarsophalangeal joint, activity, and aggravation after walking. It can be seen that the skin on the plantar side of the metatarsophalangeal joint is abnormally thickened, hardened, and can be tender, and the affected toe is affected. The gap between the skin feels normal.
3. The second metatarsal neck fracture is often caused by long-distance marching, or seen in long-distance runners. It is characterized by pain in the head and neck of the second metatarsal bone. It is aggravated after walking, and relieved after rest, but the skin between the toes is normal. Early X-ray The film is normal, and there is periosteal reaction and osteophyte formation around the second metatarsal neck.
