Neuroma mortona – Rokowania, prognozy i postęp choroby

Neuroma mortona
Rokowania, prognozy i postęp choroby

Neuroma Mortona, będąca zespołem bólowym spowodowanym uciskiem nerwu międzypalcowego, najczęściej między trzecim a czwartym palcem stopy, charakteryzuje się istotnym wpływem wielkości nerwiaka na rokowanie. Badania ultrasonograficzne wykazały, że wielkość nerwiaka jest jedynym istotnym czynnikiem prognostycznym niepowodzenia leczenia iniekcjami kortykosteroidów (P = 0,002), podczas gdy inne parametry, takie jak odległość międzyśródstopna, nie mają istotnego znaczenia (P > 0,05). Neuroma Mortona występuje około 8-krotnie częściej u kobiet w wieku 30-60 lat, co może wpływać na przebieg choroby ze względu na różnice w obciążeniu stóp i typie obuwia. Leczenie zachowawcze, obejmujące zmianę obuwia, modyfikację aktywności oraz wkładki ortopedyczne, przynosi ulgę u około 50% pacjentów, a iniekcje kortykosteroidów oraz manipulacje/mobilizacje wykazują najsilniejsze dowody skuteczności w redukcji bólu.

Prognoza w Neuroma Mortona

Czynniki wpływające na prognozę
Skuteczność leczenia zachowawczego
Skuteczność leczenia chirurgicznego
Ryzyko nawrotu po leczeniu
Luki w dowodach naukowych
Podsumowanie prognostyczne
Kolejne rozdziały

Prognoza w Neuroma Mortona

Neuroma Mortona (nerwiak Mortona) to zespół bólowy objawiający się uciskiem nerwu międzypalcowego, zazwyczaj między trzecim a czwartym palcem stopy. Prawidłowa ocena prognostyczna ma kluczowe znaczenie dla doboru odpowiedniej metody leczenia i przewidywania rezultatów terapeutycznych. ¹²

Czynniki wpływające na prognozę

Wśród czynników, które mogą wpływać na prognozę w przypadku nerwiaka Mortona, kluczową rolę odgrywa wielkość nerwiaka widoczna w badaniu ultrasonograficznym. Zgodnie z wynikami prospektywnego badania obserwacyjnego, wielkość nerwiaka okazała się jedynym istotnym czynnikiem prognostycznym niepowodzenia leczenia za pomocą iniekcji kortykosteroidów (P = 0,002). Co istotne, inne parametry, takie jak odległość międzyśródstopna czy proporcja nerwiaka w przestrzeni międzyśródstopnej, nie wykazały istotnego znaczenia w przewidywaniu klinicznego rokowania (P > 0,05). ³⁴

Należy również zauważyć, że neuroma Mortona jest około 8 razy częstsza u kobiet niż u mężczyzn i zazwyczaj dotyczy osób w wieku od 30 do 60 lat, choć może wystąpić również poza tym przedziałem wiekowym. Ta demograficzna charakterystyka może pośrednio wpływać na prognozę ze względu na różnice w nawykowo nosonym obuwiu i obciążeniu stóp. ⁵

Skuteczność leczenia zachowawczego

Rokowanie w przypadku leczenia zachowawczego nerwiaka Mortona jest zasadniczo dobre, choć wielu pacjentów może ostatecznie wymagać interwencji chirurgicznej. Większość pacjentów jest w stanie znaleźć kombinację metod leczenia, które przynoszą ulgę w objawach. ⁶⁷

Metody zachowawcze, takie jak zmiana obuwia, modyfikacja aktywności i stosowanie wkładek ortopedycznych, mogą zapewnić pewien stopień ulgi u około 50% pacjentów. ⁸

W przypadku interwencji niechirurgicznych, najsilniejsze dowody dotyczące skuteczności w redukcji bólu istnieją dla dwóch metod:

Iniekcje kortykosteroidów – metaanaliza dwóch randomizowanych badań klinicznych (RCT) wykazała, że iniekcje kortykosteroidów skuteczniej zmniejszają ból w porównaniu z grupą kontrolną. Jedno z RCT wykazało, że iniekcje kortykosteroidów były bardziej skuteczne niż odpowiednie obuwie i wyściółka w ocenie powodzenia leczenia. ⁹
Manipulacja/mobilizacja – również wykazuje obiecujące rezultaty w redukcji bólu. ¹⁰

Inne metody niechirurgiczne, dla których istnieją pewne dowody skuteczności, ale które powinny być interpretowane z ostrożnością ze względu na niższą jakość badań (serie przypadków), obejmują:

Iniekcje sklerotyzujące
Ablacja prądem o częstotliwości radiowej
Krioneuroliza
Iniekcje toksyny botulinowej ¹¹

Z kolei terapia falą uderzeniową (ESWT) i stosowanie klinów korekcyjnych stopy (przodostopie szpotawe/koślawe) nie wykazały statystycznie istotnej redukcji bólu w RCT. ¹²

Skuteczność leczenia chirurgicznego

Leczenie chirurgiczne jest często uważane za najbardziej niezawodną formę terapii w przypadku nerwiaka Mortona, z wieloma badaniami wykazującymi 80-95% skuteczność. ¹³

Interwencje chirurgiczne obejmujące neurektomię (usunięcie części nerwu) lub dekompresję nerwu mają najwyższy wskaźnik powodzenia, przy czym większość badań wykazuje 80-95% skuteczność. ¹⁴

Warto jednak odnotować, że wśród pacjentów, którzy przeszli zabieg chirurgiczny, istnieją doniesienia o wskaźniku nawrotów sięgającym nawet 50%. ¹⁵ Ta rozbieżność w wynikach może wynikać z różnic w technikach chirurgicznych, doświadczenia chirurga, a także indywidualnych czynników pacjenta.

Ryzyko nawrotu po leczeniu

Objawy nerwiaka Mortona mogą powrócić nawet po skutecznym leczeniu. Szacuje się, że u około 5-20% pacjentów po zabiegu chirurgicznym objawy mogą nawrócić, wymagając dodatkowego leczenia. ¹⁶ ¹⁷

Co istotne, ponowny zabieg chirurgiczny w przypadku nawrotu nerwiaka Mortona ma podobny wskaźnik powodzenia jak pierwotna operacja (80-95%). ¹⁸ Jest to ważna informacja, która może pomóc w podejmowaniu decyzji terapeutycznych w przypadku nawrotu objawów.

Luki w dowodach naukowych

Należy podkreślić, że baza dowodów dotyczących leczenia niechirurgicznego nerwiaka Mortona wciąż wymaga rozwoju. Przegląd systematyczny zidentyfikował siedem randomizowanych badań klinicznych i 18 serii przypadków, przy czym tylko jedno RCT było wysokiej jakości. ¹⁹ ²⁰

Brak wysokiej jakości badań eksperymentalnych badających niechirurgiczne metody leczenia nerwiaka Mortona stanowi istotną lukę w wiedzy medycznej, choć w ostatnim czasie opublikowano niewielką liczbę RCT. Konieczne są dalsze wysokiej jakości badania randomizowane, aby zapewnić solidną podstawę dowodową dla niechirurgicznego leczenia nerwiaka Mortona. ²¹

Podsumowanie prognostyczne

Na podstawie dostępnych dowodów naukowych, prognoza dla pacjentów z nerwiakiem Mortona jest zasadniczo korzystna, zwłaszcza gdy leczenie jest dostosowane do indywidualnych potrzeb pacjenta i wielkości nerwiaka. Większość pacjentów może spodziewać się powrotu do wszystkich zwykłych aktywności bez bólu, gdy zapalenie nerwu zostanie zmniejszone. ²²

Wielkość nerwiaka widoczna w badaniu ultrasonograficznym pozostaje najważniejszym czynnikiem prognostycznym, który może pomóc klinicystom w przewidywaniu odpowiedzi na leczenie zachowawcze i podejmowaniu decyzji o konieczności interwencji chirurgicznej. ²³

Niezależnie od wybranej metody leczenia, pacjenci powinni być świadomi możliwości nawrotu objawów i powinni pozostawać w kontakcie z lekarzem prowadzącym w przypadku ponownego pojawienia się bólu lub innych objawów. ²⁴

Kolejne rozdziały

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Materiały źródłowe

#1 Morton’s Neuroma – OrthoInfo – AAOS
https://orthoinfo.aaos.org/en/diseases–conditions/mortons-neuroma
Morton’s neuromas are around 8 times more common in women than men and typically affect people between the ages of 30 and 60, though they can occur outside of this age range as well. […] Surgery is often considered to be the most reliable form of treatment for a Morton’s neuroma, with many studies showing an 80 to 95% success rate. […] Conservative measures, such as changes in footwear, activity modification, and the addition of orthoses, may provide some degree of relief in up to about 50% of patients. […] Surgical intervention with neurectomy (removal of part of the nerve) or decompression of the nerve has the highest success rate, with most studies reporting an 80 to 95% success rate. […] Even after successful surgical treatment, it is possible for a Morton’s neuroma to come back. Approximately 5 to 20% of patients may have symptoms return and need additional treatment. Fortunately, a repeat surgery for Morton’s neuroma recurrence has a similar success rate to the initial surgery (80 to 95%).
#2 Physical Medicine and Rehabilitation for Morton Neuroma Follow-up: Deterrence, Complications, Prognosis
https://emedicine.medscape.com/article/308284-followup
Prognosis for recovery is good with conservative treatment; however, patients still may require surgical intervention. […] Some patients who undergo surgery report a recurrence rate of as high as 50%. […] Prediction of Clinical Prognosis according to Intermetatarsal Distance and Neuroma Size on Ultrasonography in Morton Neuroma: A Prospective Observational Study.
#3 Prediction of Clinical Prognosis according to Intermetatarsal Distance and Neuroma Size on Ultrasonography in Morton Neuroma: A Prospective Observational Study – PubMed
https://pubmed.ncbi.nlm.nih.gov/30244477/
Objectives: This study aims to evaluate the clinical importance of intermetatarsal distance, size of neuroma, and proportion of neuroma in the intermetatarsal space in examinations of Morton neuroma using ultrasonography. […] Results: Twenty-one patients (15%) did not respond to corticosteroid injections and underwent surgical treatment for Morton neuroma. Logistic regression analysis and receiver operating characteristic curve analysis showed that the size of the neuroma was the sole predictor of failure of corticosteroid injections (P = .002). No other factors were significant for the prediction of clinical prognosis (P .05). […] Conclusions: The size of the neuroma on ultrasonography is the sole predictor of corticosteroid injection failure, while intermetatarsal distance and proportion of neuroma in the intermetatarsal space are not significant when predicting clinical prognosis of Morton neuroma.
#4 Physical Medicine and Rehabilitation for Morton Neuroma Follow-up: Deterrence, Complications, Prognosis
https://emedicine.medscape.com/article/308284-followup
Prognosis for recovery is good with conservative treatment; however, patients still may require surgical intervention. […] Some patients who undergo surgery report a recurrence rate of as high as 50%. […] Prediction of Clinical Prognosis according to Intermetatarsal Distance and Neuroma Size on Ultrasonography in Morton Neuroma: A Prospective Observational Study.
#5 Morton’s Neuroma – OrthoInfo – AAOS
https://orthoinfo.aaos.org/en/diseases–conditions/mortons-neuroma
Morton’s neuromas are around 8 times more common in women than men and typically affect people between the ages of 30 and 60, though they can occur outside of this age range as well. […] Surgery is often considered to be the most reliable form of treatment for a Morton’s neuroma, with many studies showing an 80 to 95% success rate. […] Conservative measures, such as changes in footwear, activity modification, and the addition of orthoses, may provide some degree of relief in up to about 50% of patients. […] Surgical intervention with neurectomy (removal of part of the nerve) or decompression of the nerve has the highest success rate, with most studies reporting an 80 to 95% success rate. […] Even after successful surgical treatment, it is possible for a Morton’s neuroma to come back. Approximately 5 to 20% of patients may have symptoms return and need additional treatment. Fortunately, a repeat surgery for Morton’s neuroma recurrence has a similar success rate to the initial surgery (80 to 95%).
#6 Physical Medicine and Rehabilitation for Morton Neuroma Follow-up: Deterrence, Complications, Prognosis
https://emedicine.medscape.com/article/308284-followup
Prognosis for recovery is good with conservative treatment; however, patients still may require surgical intervention. […] Some patients who undergo surgery report a recurrence rate of as high as 50%. […] Prediction of Clinical Prognosis according to Intermetatarsal Distance and Neuroma Size on Ultrasonography in Morton Neuroma: A Prospective Observational Study.
#7 Mortonâs Neuroma: Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/15118-mortons-neuroma
Most people with a Mortons neuroma are able to find a combination of treatments that relieves their symptoms. You should be able to return to all your usual activities pain-free once your affected nerve is less inflamed. […] Mortons neuroma symptoms can come back. Talk to your provider if you experience pain and symptoms after treatment.
#8 Morton’s Neuroma – OrthoInfo – AAOS
https://orthoinfo.aaos.org/en/diseases–conditions/mortons-neuroma
Morton’s neuromas are around 8 times more common in women than men and typically affect people between the ages of 30 and 60, though they can occur outside of this age range as well. […] Surgery is often considered to be the most reliable form of treatment for a Morton’s neuroma, with many studies showing an 80 to 95% success rate. […] Conservative measures, such as changes in footwear, activity modification, and the addition of orthoses, may provide some degree of relief in up to about 50% of patients. […] Surgical intervention with neurectomy (removal of part of the nerve) or decompression of the nerve has the highest success rate, with most studies reporting an 80 to 95% success rate. […] Even after successful surgical treatment, it is possible for a Morton’s neuroma to come back. Approximately 5 to 20% of patients may have symptoms return and need additional treatment. Fortunately, a repeat surgery for Morton’s neuroma recurrence has a similar success rate to the initial surgery (80 to 95%).
#9 The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Mortonâs neuroma): a systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC6375221/
Corticosteroid injections and manipulation/mobilisation are the two interventions with the strongest evidence for pain reduction, however high-quality evidence for a gold standard intervention was not found. […] Although the evidence base is expanding, further high quality RCTs are needed. […] The review identified seven RCTs and 18 case series with only one high quality RCT. […] Meta-analysis of two RCTs found that corticosteroid injection decreased pain more than control. […] One RCT showed that corticosteroid injection was superior to footwear and padding when measuring treatment success. […] Several case series found a reduction in pre/post pain with sclerosing injections, radiofrequency ablation, cryoneurolysis, and Botox injection but these results should be interpreted with caution.
#10 The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Mortonâs neuroma): a systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC6375221/
Corticosteroid injections and manipulation/mobilisation are the two interventions with the strongest evidence for pain reduction, however high-quality evidence for a gold standard intervention was not found. […] Although the evidence base is expanding, further high quality RCTs are needed. […] The review identified seven RCTs and 18 case series with only one high quality RCT. […] Meta-analysis of two RCTs found that corticosteroid injection decreased pain more than control. […] One RCT showed that corticosteroid injection was superior to footwear and padding when measuring treatment success. […] Several case series found a reduction in pre/post pain with sclerosing injections, radiofrequency ablation, cryoneurolysis, and Botox injection but these results should be interpreted with caution.
#11 The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Mortonâs neuroma): a systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC6375221/
Corticosteroid injections and manipulation/mobilisation are the two interventions with the strongest evidence for pain reduction, however high-quality evidence for a gold standard intervention was not found. […] Although the evidence base is expanding, further high quality RCTs are needed. […] The review identified seven RCTs and 18 case series with only one high quality RCT. […] Meta-analysis of two RCTs found that corticosteroid injection decreased pain more than control. […] One RCT showed that corticosteroid injection was superior to footwear and padding when measuring treatment success. […] Several case series found a reduction in pre/post pain with sclerosing injections, radiofrequency ablation, cryoneurolysis, and Botox injection but these results should be interpreted with caution.
#12 The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Mortonâs neuroma): a systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC6375221/
No statistically significant reduction in pain was demonstrated by an RCT investigating ESWT compared to control or by another RCT comparing varus/valgus foot wedges. […] High quality experimental studies investigating non-surgical treatments for MN are lacking, although there has been a small number of RCTs recently published. […] Further high quality RCTs are warranted to provide a solid evidence base for non-surgical treatment of MN.
#13 Morton’s Neuroma – OrthoInfo – AAOS
https://orthoinfo.aaos.org/en/diseases–conditions/mortons-neuroma
Morton’s neuromas are around 8 times more common in women than men and typically affect people between the ages of 30 and 60, though they can occur outside of this age range as well. […] Surgery is often considered to be the most reliable form of treatment for a Morton’s neuroma, with many studies showing an 80 to 95% success rate. […] Conservative measures, such as changes in footwear, activity modification, and the addition of orthoses, may provide some degree of relief in up to about 50% of patients. […] Surgical intervention with neurectomy (removal of part of the nerve) or decompression of the nerve has the highest success rate, with most studies reporting an 80 to 95% success rate. […] Even after successful surgical treatment, it is possible for a Morton’s neuroma to come back. Approximately 5 to 20% of patients may have symptoms return and need additional treatment. Fortunately, a repeat surgery for Morton’s neuroma recurrence has a similar success rate to the initial surgery (80 to 95%).
#14 Morton’s Neuroma – OrthoInfo – AAOS
https://orthoinfo.aaos.org/en/diseases–conditions/mortons-neuroma
Morton’s neuromas are around 8 times more common in women than men and typically affect people between the ages of 30 and 60, though they can occur outside of this age range as well. […] Surgery is often considered to be the most reliable form of treatment for a Morton’s neuroma, with many studies showing an 80 to 95% success rate. […] Conservative measures, such as changes in footwear, activity modification, and the addition of orthoses, may provide some degree of relief in up to about 50% of patients. […] Surgical intervention with neurectomy (removal of part of the nerve) or decompression of the nerve has the highest success rate, with most studies reporting an 80 to 95% success rate. […] Even after successful surgical treatment, it is possible for a Morton’s neuroma to come back. Approximately 5 to 20% of patients may have symptoms return and need additional treatment. Fortunately, a repeat surgery for Morton’s neuroma recurrence has a similar success rate to the initial surgery (80 to 95%).
#15 Physical Medicine and Rehabilitation for Morton Neuroma Follow-up: Deterrence, Complications, Prognosis
https://emedicine.medscape.com/article/308284-followup
Prognosis for recovery is good with conservative treatment; however, patients still may require surgical intervention. […] Some patients who undergo surgery report a recurrence rate of as high as 50%. […] Prediction of Clinical Prognosis according to Intermetatarsal Distance and Neuroma Size on Ultrasonography in Morton Neuroma: A Prospective Observational Study.
#16 Morton’s Neuroma – OrthoInfo – AAOS
https://orthoinfo.aaos.org/en/diseases–conditions/mortons-neuroma
Morton’s neuromas are around 8 times more common in women than men and typically affect people between the ages of 30 and 60, though they can occur outside of this age range as well. […] Surgery is often considered to be the most reliable form of treatment for a Morton’s neuroma, with many studies showing an 80 to 95% success rate. […] Conservative measures, such as changes in footwear, activity modification, and the addition of orthoses, may provide some degree of relief in up to about 50% of patients. […] Surgical intervention with neurectomy (removal of part of the nerve) or decompression of the nerve has the highest success rate, with most studies reporting an 80 to 95% success rate. […] Even after successful surgical treatment, it is possible for a Morton’s neuroma to come back. Approximately 5 to 20% of patients may have symptoms return and need additional treatment. Fortunately, a repeat surgery for Morton’s neuroma recurrence has a similar success rate to the initial surgery (80 to 95%).
#17 Mortonâs Neuroma: Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/15118-mortons-neuroma
Most people with a Mortons neuroma are able to find a combination of treatments that relieves their symptoms. You should be able to return to all your usual activities pain-free once your affected nerve is less inflamed. […] Mortons neuroma symptoms can come back. Talk to your provider if you experience pain and symptoms after treatment.
#18 Morton’s Neuroma – OrthoInfo – AAOS
https://orthoinfo.aaos.org/en/diseases–conditions/mortons-neuroma
Morton’s neuromas are around 8 times more common in women than men and typically affect people between the ages of 30 and 60, though they can occur outside of this age range as well. […] Surgery is often considered to be the most reliable form of treatment for a Morton’s neuroma, with many studies showing an 80 to 95% success rate. […] Conservative measures, such as changes in footwear, activity modification, and the addition of orthoses, may provide some degree of relief in up to about 50% of patients. […] Surgical intervention with neurectomy (removal of part of the nerve) or decompression of the nerve has the highest success rate, with most studies reporting an 80 to 95% success rate. […] Even after successful surgical treatment, it is possible for a Morton’s neuroma to come back. Approximately 5 to 20% of patients may have symptoms return and need additional treatment. Fortunately, a repeat surgery for Morton’s neuroma recurrence has a similar success rate to the initial surgery (80 to 95%).
#19 The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Mortonâs neuroma): a systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC6375221/
Corticosteroid injections and manipulation/mobilisation are the two interventions with the strongest evidence for pain reduction, however high-quality evidence for a gold standard intervention was not found. […] Although the evidence base is expanding, further high quality RCTs are needed. […] The review identified seven RCTs and 18 case series with only one high quality RCT. […] Meta-analysis of two RCTs found that corticosteroid injection decreased pain more than control. […] One RCT showed that corticosteroid injection was superior to footwear and padding when measuring treatment success. […] Several case series found a reduction in pre/post pain with sclerosing injections, radiofrequency ablation, cryoneurolysis, and Botox injection but these results should be interpreted with caution.
#20 The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Mortonâs neuroma): a systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC6375221/
No statistically significant reduction in pain was demonstrated by an RCT investigating ESWT compared to control or by another RCT comparing varus/valgus foot wedges. […] High quality experimental studies investigating non-surgical treatments for MN are lacking, although there has been a small number of RCTs recently published. […] Further high quality RCTs are warranted to provide a solid evidence base for non-surgical treatment of MN.
#21 The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Mortonâs neuroma): a systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC6375221/
No statistically significant reduction in pain was demonstrated by an RCT investigating ESWT compared to control or by another RCT comparing varus/valgus foot wedges. […] High quality experimental studies investigating non-surgical treatments for MN are lacking, although there has been a small number of RCTs recently published. […] Further high quality RCTs are warranted to provide a solid evidence base for non-surgical treatment of MN.
#22 Mortonâs Neuroma: Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/15118-mortons-neuroma
Most people with a Mortons neuroma are able to find a combination of treatments that relieves their symptoms. You should be able to return to all your usual activities pain-free once your affected nerve is less inflamed. […] Mortons neuroma symptoms can come back. Talk to your provider if you experience pain and symptoms after treatment.
#23 Prediction of Clinical Prognosis according to Intermetatarsal Distance and Neuroma Size on Ultrasonography in Morton Neuroma: A Prospective Observational Study – PubMed
https://pubmed.ncbi.nlm.nih.gov/30244477/
Objectives: This study aims to evaluate the clinical importance of intermetatarsal distance, size of neuroma, and proportion of neuroma in the intermetatarsal space in examinations of Morton neuroma using ultrasonography. […] Results: Twenty-one patients (15%) did not respond to corticosteroid injections and underwent surgical treatment for Morton neuroma. Logistic regression analysis and receiver operating characteristic curve analysis showed that the size of the neuroma was the sole predictor of failure of corticosteroid injections (P = .002). No other factors were significant for the prediction of clinical prognosis (P .05). […] Conclusions: The size of the neuroma on ultrasonography is the sole predictor of corticosteroid injection failure, while intermetatarsal distance and proportion of neuroma in the intermetatarsal space are not significant when predicting clinical prognosis of Morton neuroma.
#24 Mortonâs Neuroma: Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/15118-mortons-neuroma
Most people with a Mortons neuroma are able to find a combination of treatments that relieves their symptoms. You should be able to return to all your usual activities pain-free once your affected nerve is less inflamed. […] Mortons neuroma symptoms can come back. Talk to your provider if you experience pain and symptoms after treatment.