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莫顿神经瘤：认识疾病与矫形器的作用

第3、4趾之间前足灼痛或麻木？基于PubMed证据的诊断、阶梯式治疗，以及为什么鞋垫和跖骨垫是第一步。

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莫顿神经瘤：认识疾病与矫形器的作用

莫顿神经瘤是前足（多在第3、4趾之间）刺痛、灼痛或麻木的主要原因。好消息是大多数人无需手术即可改善，矫形器和合适的鞋是治疗的第一步。

以下为PubMed证据的摘要。含表格的完整文章提供越南语和英语版本。

要点

  • 它不是真正的肿瘤，也不是癌症：跖骨之间的神经被反复挤压和刺激。
  • 中年女性发病至少是男性的5倍；危险因素包括窄头鞋、高跟鞋和脚趾畸形。
  • 诊断主要靠临床检查；超声和MRI准确性相近（敏感度0.91和0.90）。
  • 阶梯式治疗：1）鞋和矫形器，2）皮质类固醇注射，3）保守治疗失败时手术。
  • 只做内倾或外倾的鞋垫不被推荐，需要对跖骨头区域减压。
How to read: three steps rising from left to right. Start at step 1 and move up only if, after about 3 months, relief is not enough. STEP 1 – wide-toe shoes plus orthoses: about 41% improved enough not to need more treatment (Bennett 1995; 47/115 patients). STEP 2 – corticosteroid injection: pain relief and better function for at least 3 months (Thomson 2013; 131 patients). STEP 3 – surgery when conservative treatment fails: 82% good or very good results but 71% still limited in choosing shoes (Pace 2010). Orthoses accompany the patient at all three steps.
How to read: three steps rising from left to right. Start at step 1 and move up only if, after about 3 months, relief is not enough. STEP 1 – wide-toe shoes plus orthoses: about 41% improved enough not to need more treatment (Bennett 1995; 47/115 patients). STEP 2 – corticosteroid injection: pain relief and better function for at least 3 months (Thomson 2013; 131 patients). STEP 3 – surgery when conservative treatment fails: 82% good or very good results but 71% still limited in choosing shoes (Pace 2010). Orthoses accompany the patient at all three steps.

科学证据

  • 同一项巴西随机试验：在第6、12、24周随访，定制鞋垫优于平面鞋垫。
  • 跖骨垫可降低前足峰值压力，放在跖骨头后方约5mm处平衡最佳。
  • 12个月后，换鞋加矫形器组63%、注射组82%疼痛完全或部分缓解，差异随时间不再显著（低质量研究）。
  • 神经切除术后82%效果良好，但71%选鞋仍受限。
Ultrasound: a hypoechoic mass (arrow) between the metatarsal heads (source: dungcuchinhhinh.vn)
Ultrasound: a hypoechoic mass (arrow) between the metatarsal heads (source: dungcuchinhhinh.vn)
Axial MRI of the forefoot: Morton’s neuroma (arrow) (source: dungcuchinhhinh.vn)
Axial MRI of the forefoot: Morton’s neuroma (arrow) (source: dungcuchinhhinh.vn)
Intra-operative view: Morton’s neuroma (arrow) (source: dungcuchinhhinh.vn)
Intra-operative view: Morton’s neuroma (arrow) (source: dungcuchinhhinh.vn)

实用建议

  • 选择鞋头宽、鞋跟低的鞋，在脚最肿的傍晚试穿。
  • 判断是否进入下一步前，至少坚持使用矫形器3个月；鞋垫要坚持穿并定期检查磨损。
  • 鞋垫应由矫形专业人员评估和调整：垫子偏移几毫米就会改变压力分布。
  • 疼痛持续数周以上，或有肿胀、发红、外伤、糖尿病时请就医。

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如果前足有灼痛或麻木，请预约测量足部并咨询个性化矫形鞋垫：+84 985 211 888。本文仅供健康教育。

参考文献

  1. Morton Neuroma. StatPearls, NCBI Bookshelf.
  2. Morton’s neuroma – Current concepts review. J Clin Orthop Trauma. 2020. PMID 32405199.
  3. Sharp RJ, Wade CM, Hennessy MS, Saxby TS. The role of MRI and ultrasound imaging in Morton’s neuroma and the effect of size of lesion on symptoms. J Bone Joint Surg Br. 2003;85(7):999–1005.
  4. Xu Z, et al. Ultrasound versus magnetic resonance imaging for Morton neuroma: systematic review and meta-analysis. Eur Radiol. 2015. PMID 25809742.
  5. MRI and ultrasonography in Morton’s neuroma: diagnostic accuracy and correlation. PMID 22719120.
  6. de Oliveira HAV, Natour J, Vassalli M, Rosenfeld A, Jennings F, Jones A. Effectiveness of customized insoles in patients with Morton’s neuroma: a randomized, controlled, double-blind clinical trial. Clin Rehabil. 2019;33(12):1898–1907. PMID 31505943.
  7. Kilmartin TE, Wallace WA. Effect of pronation and supination orthosis on Morton’s neuroma and lower extremity function. Foot Ankle Int. 1994;15(5):256–262.
  8. Bennett GL, Graham CE, Mauldin DM. Morton’s interdigital neuroma: a comprehensive treatment protocol. Foot Ankle Int. 1995;16(12):760–763. PMID 8749346.
  9. Saygi B, Yildirim Y, Saygi EK, Kara H, Esemenli T. Morton neuroma: comparative results of two conservative methods. Foot Ankle Int. 2005;26(7):556–559.
  10. Thomson CE, Beggs I, Martin DJ, et al. Methylprednisolone injections for the treatment of Morton neuroma: a patient-blinded randomized trial. J Bone Joint Surg Am. 2013;95(9):790–798.
  11. Matthews BG, Hurn SE, Harding MP, Henry RA, Ware RS. The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Morton’s neuroma): a systematic review and meta-analysis. J Foot Ankle Res. 2019;12:12. PMID 30809275.
  12. Effects of metatarsal domes on plantar pressures in older people with a history of forefoot pain. J Foot Ankle Res.
  13. Pace A, Scammell B, Dhar S. The outcome of Morton’s neurectomy in the treatment of metatarsalgia. Int Orthop. 2010;34(4). PMID 19484237.
  14. Nery CAS, Barroco RS, Furlan C, et al. Morton’s neuroma treatment through plantar port: retrospective assessment of surgical outcomes. Acta Ortop Bras. 2007;15(1):55–58.
  15. Long-term results of dorsal neuroma/nerve transposition in the surgical management of Morton’s neuroma and correlation with intraoperative anatomical variations. J Orthop Surg Res. 2022. PMID 35033145.
  16. Thomson CE, Gibson JNA, Martin D. Interventions for the treatment of Morton’s neuroma. Cochrane Database Syst Rev. 2004;(3):CD003118.
  17. Hình ảnh minh họa / Illustrations: dungcuchinhhinh.vn (website của Lê Hoàn Prosthetics & Orthotics)

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