{"id":4808,"date":"2023-02-08T15:00:48","date_gmt":"2023-02-08T15:00:48","guid":{"rendered":"https:\/\/langs.physio-pedia.com\/physiotherapy-for-mortons-neuroma-it\/"},"modified":"2023-02-08T19:57:31","modified_gmt":"2023-02-08T19:57:31","slug":"physiotherapy-for-mortons-neuroma-it","status":"publish","type":"page","link":"https:\/\/langs.physio-pedia.com\/it\/physiotherapy-for-mortons-neuroma-it\/","title":{"rendered":"Fisioterapia per il neuroma di Morton"},"content":{"rendered":"<div class=\"mw-parser-output\">\n<div class=\"editorbox\"><b>Editrice principale<\/b> &#8211; <a title=\"User:Ewa Jaraczewska\" href=\"\/User:Ewa_Jaraczewska\">Ewa Jaraczewska<\/a><br \/>\n<b>Collaboratori principali<\/b> &#8211; <a class=\"mw-userlink\" title=\"User:Ewa Jaraczewska\" href=\"\/User:Ewa_Jaraczewska\"><bdi>Ewa Jaraczewska<\/bdi><\/a> e <a class=\"mw-userlink\" title=\"User:Jess Bell\" href=\"\/User:Jess_Bell\"><bdi>Jess Bell<\/bdi><\/a><\/div>\n<div id=\"toc\" class=\"toc\" role=\"navigation\" aria-labelledby=\"mw-toc-heading\"><input id=\"toctogglecheckbox\" class=\"toctogglecheckbox\" style=\"display: none;\" role=\"button\" type=\"checkbox\"><\/p>\n<div class=\"toctitle\" dir=\"ltr\" lang=\"en\">\n<h2 id=\"mw-toc-heading\">Contenuti<\/h2>\n<\/div>\n<ul>\n<li class=\"toclevel-1 tocsection-1\"><a href=\"#Introduction\"><span class=\"tocnumber\">1<\/span> <span class=\"toctext\">Introduzione<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-2\"><a href=\"#Clinically_Relevant_Anatomy\"><span class=\"tocnumber\">2<\/span> <span class=\"toctext\">Anatomia clinicamente rilevante<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-3\"><a href=\"#Neuroma\"><span class=\"tocnumber\">2.1<\/span> <span class=\"toctext\">Neuroma<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-4\"><a href=\"#Aetiology\"><span class=\"tocnumber\">3<\/span> <span class=\"toctext\">Eziologia<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-5\"><a href=\"#Epidemiology\"><span class=\"tocnumber\">3.1<\/span> <span class=\"toctext\">Epidemiologia<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-6\"><a href=\"#Mechanism_of_Injury_.2F_Pathological_Process\"><span class=\"tocnumber\">4<\/span> <span class=\"toctext\">Meccanismo di lesione \/ Processo patologico<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-7\"><a href=\"#Clinical_Presentation\"><span class=\"tocnumber\">5<\/span> <span class=\"toctext\">Presentazione clinica<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-8\"><a href=\"#Diagnostic_Tests\"><span class=\"tocnumber\">6<\/span> <span class=\"toctext\">Test diagnostici<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-9\"><a href=\"#Diagnostic_Procedures\"><span class=\"tocnumber\">7<\/span> <span class=\"toctext\">Procedure diagnostiche<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-10\"><a href=\"#Differential_Diagnosis\"><span class=\"tocnumber\">8<\/span> <span class=\"toctext\">Diagnosi differenziale<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-11\"><a href=\"#Physiotherapy_Management_.2F_Interventions\"><span class=\"tocnumber\">9<\/span> <span class=\"toctext\">Gestione fisioterapica \/ Interventi<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-12\"><a href=\"#Footwear\"><span class=\"tocnumber\">9.1<\/span> <span class=\"toctext\">Calzature<\/span><\/a>\n<ul>\n<li class=\"toclevel-3 tocsection-13\"><a href=\"#Patient_Education\"><span class=\"tocnumber\">9.1.1<\/span> <span class=\"toctext\">Educazione del paziente<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-14\"><a href=\"#Footwear_Modification\"><span class=\"tocnumber\">9.1.2<\/span> <span class=\"toctext\">Modifica delle calzature<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-2 tocsection-15\"><a href=\"#Orthotics\"><span class=\"tocnumber\">9.2<\/span> <span class=\"toctext\">Ortesi<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-16\"><a href=\"#Steroid_Injections\"><span class=\"tocnumber\">9.3<\/span> <span class=\"toctext\">Iniezioni di steroidi<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-17\"><a href=\"#Modality\"><span class=\"tocnumber\">9.4<\/span> <span class=\"toctext\">Modalit\u00e0<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-18\"><a href=\"#Manipulation.2FMobilisation\"><span class=\"tocnumber\">9.5<\/span> <span class=\"toctext\">Manipolazione\/Mobilizzazione<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-19\"><a href=\"#Strengthening_Exercises\"><span class=\"tocnumber\">9.6<\/span> <span class=\"toctext\">Esercizi di rinforzo<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-20\"><a href=\"#Other_Treatment_Options\"><span class=\"tocnumber\">10<\/span> <span class=\"toctext\">Altre opzioni di trattamento<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-21\"><a href=\"#Resources\"><span class=\"tocnumber\">11<\/span> <span class=\"toctext\">Risorse<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-22\"><a href=\"#References\"><span class=\"tocnumber\">12<\/span> <span class=\"toctext\">Citazioni<\/span><\/a><\/li>\n<\/ul>\n<\/div>\n<h2><span id=\"Introduction\" class=\"mw-headline\">Introduzione<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Introduction\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=1\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Introduction\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=1\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>La sindrome di Civinini Morton (CMS) \u00e8 pi\u00f9 comunemente nota come neuroma di Morton. Weinfield e Myerson<sup id=\"cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\">(1)<\/a><\/sup> hanno proposto anche il termine &#8220;neurite interdigitale&#8221;, che descrive meglio la patologia di questa condizione. La degenerazione neurale e la fibrosi perineurale sono tipiche del neuroma di Morton<sup id=\"cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\">(2)<\/a><\/sup>; la presenza di tessuto infiammatorio all&#8217;esame istologico giustifica la descrizione del neuroma di Morton come fibrosi perineurale.<sup id=\"cite_ref-:10_3-0\" class=\"reference\"><a href=\"#cite_note-:10-3\">(3)<\/a><\/sup> I sintomi clinici che possono aiutare nella diagnosi sono il dolore e una sensazione anomala nell&#8217;avampiede. Il trattamento conservativo, compreso l&#8217;adeguamento dello stile di vita, potrebbe non essere sempre praticabile. Pertanto, i pazienti potrebbero scegliere di sottoporsi a un intervento chirurgico o a vari tipi di iniezioni percutanee ecoguidate per gestire questa condizione.<\/p>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Foot_Inneravtion.gif\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/6\/69\/Foot_Inneravtion.gif\/300px-Foot_Inneravtion.gif\" srcset=\"https:\/\/www.physio-pedia.com\/images\/6\/69\/Foot_Inneravtion.gif 1.5x\" alt=\"\" width=\"300\" height=\"323\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Innervazione del piede<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h2><span id=\"Clinically_Relevant_Anatomy\" class=\"mw-headline\">Anatomia clinicamente rilevante<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Clinically Relevant Anatomy\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=2\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Clinically Relevant Anatomy\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=2\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>La risonanza magnetica (RM) mostra i <a title=\"Lateral Plantar Nerve\" href=\"\/Lateral_Plantar_Nerve\">nervi plantari laterale<\/a> e <a title=\"Medial Plantar Nerve\" href=\"\/Medial_Plantar_Nerve\">mediale<\/a> che derivano dal <a title=\"Tibial Nerve\" href=\"\/Tibial_Nerve\">nervo tibiale<\/a> posteriore.<sup id=\"cite_ref-:7_4-0\" class=\"reference\"><a href=\"#cite_note-:7-4\">(4)<\/a><\/sup> La biforcazione del nervo tibiale avviene all&#8217;interno del retinacolo o prossimalmente al retinacolo dei flessori.<sup id=\"cite_ref-:8_5-0\" class=\"reference\"><a href=\"#cite_note-:8-5\">(5)<\/a><\/sup> I due nervi plantari penetrano nel tunnel costituito dalla fascia profonda del <a title=\"Abductor Hallucis\" href=\"\/Abductor_Hallucis\">muscolo abduttore dell&#8217;alluce<\/a> e dal setto fibroso, che collega la fascia all&#8217;osso.<sup id=\"cite_ref-:8_5-1\" class=\"reference\"><a href=\"#cite_note-:8-5\">(5)<\/a><\/sup><\/p>\n<p>Il <a title=\"Medial Plantar Nerve\" href=\"\/Medial_Plantar_Nerve\">nervo plantare mediale<\/a> (MPN) \u00e8 il pi\u00f9 grande dei due nervi plantari. Ha origine sotto il retinacolo dei flessori (noto anche come legamento laciniato) e passa tra l&#8217;<a title=\"Abductor Hallucis\" href=\"\/Abductor_Hallucis\">abduttore dell&#8217;alluce<\/a> e il <a title=\"Flexor Digitorum Brevis\" href=\"\/Flexor_Digitorum_Brevis\">flessore breve delle dita<\/a>. Una volta raggiunte le basi metatarsali, si divide in tre nervi plantari digitali comuni.<sup id=\"cite_ref-:9_6-0\" class=\"reference\"><a href=\"#cite_note-:9-6\">(6)<\/a><\/sup> Il nervo plantare mediale innerva l&#8217;abduttore dell&#8217;alluce, il <a title=\"Flexor Hallucis Brevis\" href=\"\/Flexor_Hallucis_Brevis\">flessore breve dell&#8217;alluce<\/a>, il flessore breve delle dita e il primo lombricale del piede.<\/p>\n<p>Il <a title=\"Lateral Plantar Nerve\" href=\"\/Lateral_Plantar_Nerve\">nervo plantare laterale<\/a> (LPN) innerva l&#8217;<a title=\"Abductor Digiti Minimi (Foot)\" href=\"\/Abductor_Digiti_Minimi_(Foot)\">abduttore del mignolo<\/a>, il <a title=\"Flexor Digiti Minimi Brevis\" href=\"\/Flexor_Digiti_Minimi_Brevis\">flessore breve del mignolo<\/a>, il <a title=\"Quadrato plantare\" href=\"\/Quadratus_Plantae\">quadrato plantare<\/a>, i tre lombricali laterali del piede, l&#8217;<a title=\"Adductor Hallucis\" href=\"\/Adductor_Hallucis\">adduttore dell&#8217;alluce<\/a>, gli interossei plantari e gli <a title=\"Dorsal Interossei of the Foot\" href=\"\/Dorsal_Interossei_of_the_Foot\">interossei dorsali<\/a>.<\/p>\n<p>I nervi plantari digitali comuni (CPD) passano sotto i legamenti intermetatarsali. Attraversano l&#8217;<a title=\"Aponeurosis\" href=\"\/Aponeurosis\">aponeurosi<\/a> plantare e si dividono in due rami, che riforniscono la pelle plantare delle dita dei piedi. Porzioni pi\u00f9 piccole dei nervi plantari digitali comuni innervano i <a title=\"Metatarsals\" href=\"\/Metatarsals\">metatarsi<\/a> adiacenti, le articolazioni metatarso-falangee e la cute plantare sotto le teste metatarsali.<sup id=\"cite_ref-:5_7-0\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup><\/p>\n<p>Il <i>terzo nervo digitale comune<\/i> inizia come nervo plantare mediale e riceve un ramo comunicante dal nervo plantare laterale. Poich\u00e9 passa attraverso lo spazio stretto in profondit\u00e0 del legamento metatarsale trasverso, diventa meno mobile, soprattutto durante le attivit\u00e0 in carico.<sup id=\"cite_ref-:5_7-1\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup><\/p>\n<p>I rami del nervo digitale comune nel terzo spazio interdigitale plantare sono i pi\u00f9 comunemente colpiti dal neuroma di Morton. \u00c8 stato proposto che la posizione di questo nervo (ossia vicino allo stretto spazio del legamento metatarsale trasverso) potrebbe essere il motivo per cui il neuroma di Morton si verifica spesso nel terzo spazio intermetatarsale.<sup id=\"cite_ref-:5_7-2\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup><\/p>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Mortons-neuroma-1.gif\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/4\/4b\/Mortons-neuroma-1.gif\/300px-Mortons-neuroma-1.gif\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/4\/4b\/Mortons-neuroma-1.gif\/450px-Mortons-neuroma-1.gif 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/4\/4b\/Mortons-neuroma-1.gif\/600px-Mortons-neuroma-1.gif 2x\" alt=\"\" width=\"300\" height=\"225\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Neuroma di Morton<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h3><span id=\"Neuroma\" class=\"mw-headline\">Neuroma<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Neuroma\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=3\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Neuroma\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=3\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Un neuroma viene anche chiamato &#8220;nervo schiacciato&#8221;. Il neuroma di Morton \u00e8 una neuropatia compressiva del nervo plantare digitale comune causata da un intrappolamento del nervo tra i legamenti intermetatarsali.<\/p>\n<h2><span id=\"Aetiology\" class=\"mw-headline\">Eziologia<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Aetiology\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=4\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Aetiology\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=4\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Esistono diverse teorie eziopatogenetiche alla base dello sviluppo del neuroma di Morton. Queste includono:<\/p>\n<ul>\n<li>Danno da trazione cronica<sup id=\"cite_ref-:6_8-0\" class=\"reference\"><a href=\"#cite_note-:6-8\">(8)<\/a><\/sup><\/li>\n<li>Trauma cronico e ripetitivo<sup id=\"cite_ref-:6_8-1\" class=\"reference\"><a href=\"#cite_note-:6-8\">(8)<\/a><\/sup><\/li>\n<li>Ischemia dei vasa nervorum (Vasa nervorum = vasi nutritivi che forniscono l&#8217;apporto di sangue a ciascun nervo periferico dai vasi sanguigni adiacenti)<sup id=\"cite_ref-:5_7-3\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup><sup id=\"cite_ref-:6_8-2\" class=\"reference\"><a href=\"#cite_note-:6-8\">(8)<\/a><\/sup><\/li>\n<li>Intrappolamento o compressione meccanica<sup id=\"cite_ref-:10_3-1\" class=\"reference\"><a href=\"#cite_note-:10-3\">(3)<\/a><\/sup><sup id=\"cite_ref-:0_9-0\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup><\/li>\n<li>Infiammazione dovuta alla borsite intermetatarsale<sup id=\"cite_ref-:10_3-2\" class=\"reference\"><a href=\"#cite_note-:10-3\">(3)<\/a><\/sup><\/li>\n<\/ul>\n<p><b>Considerazioni anatomiche:<\/b><\/p>\n<ul>\n<li>Il terzo nervo digitale comune \u00e8 pi\u00f9 spesso degli altri a causa di un&#8217;anastomosi tra due tronchi nervosi<sup id=\"cite_ref-:5_7-4\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup><\/li>\n<li>Il quarto raggio \u00e8 pi\u00f9 mobile del terzo, il che potrebbe portare a un&#8217;infiammazione<sup id=\"cite_ref-:5_7-5\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup><\/li>\n<li>Il nervo plantare \u00e8 compresso dal legamento trasverso metatarsale distale<sup id=\"cite_ref-:10_3-3\" class=\"reference\"><a href=\"#cite_note-:10-3\">(3)<\/a><\/sup><\/li>\n<\/ul>\n<h3><span id=\"Epidemiology\" class=\"mw-headline\">Epidemiologia<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Epidemiology\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=5\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Epidemiology\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=5\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Il neuroma di Morton \u00e8 pi\u00f9 comune nelle donne che negli uomini, con un rapporto di 5:1.<sup id=\"cite_ref-:5_7-6\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup> Colpisce circa il 30% della popolazione. L&#8217;et\u00e0 media del neuroma di Morton \u00e8 di 50 anni. Colpisce entrambi i piedi e, nella maggior parte dei casi, \u00e8 coinvolto il terzo spazio intermetatarsale, seguito dal secondo (neuroma di Hauser).<sup id=\"cite_ref-:1_10-0\" class=\"reference\"><a href=\"#cite_note-:1-10\">(10)<\/a><\/sup> Molteplici sedi sono rare.<sup id=\"cite_ref-:5_7-7\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup><\/p>\n<h2><span id=\"Mechanism_of_Injury_\/_Pathological_Process\"><\/span><span id=\"Mechanism_of_Injury_.2F_Pathological_Process\" class=\"mw-headline\">Meccanismo di lesione \/ Processo patologico<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Mechanism of Injury \/ Pathological Process\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=6\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Mechanism of Injury \/ Pathological Process\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=6\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Secondo la letteratura, il meccanismo di lesione pi\u00f9 frequente \u00e8 l&#8217;intrappolamento del nervo.<sup id=\"cite_ref-:0_9-1\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup> Poich\u00e9 il terzo nervo digitale comune \u00e8 pi\u00f9 spesso a causa della fusione dei nervi plantari mediale e laterale, pu\u00f2 essere intrappolato dal legamento circostante.<sup id=\"cite_ref-:0_9-2\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup> La neuropatia da intrappolamento causa fibrosi perineurale e degenerazione del nervo.<sup id=\"cite_ref-:0_9-3\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup> L&#8217;ispessimento del nervo progredisce a causa della ialinizzazione vascolare, che provoca un maggiore trauma e intrappolamento del nervo. Anche l&#8217;uso di scarpe con il tacco alto pu\u00f2 aggravare il processo patologico, poich\u00e9 queste calzature causano un eccessivo carico del peso corporeo sull&#8217;avampiede.<sup id=\"cite_ref-:0_9-4\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup><\/p>\n<h2><span id=\"Clinical_Presentation\" class=\"mw-headline\">Presentazione clinica<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Clinical Presentation\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=7\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Clinical Presentation\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=7\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>I soggetti affetti da neuroma di Morton possono essere clinicamente sintomatici o asintomatici. Le persone con neuroma di Morton clinicamente sintomatico potrebbero presentare i seguenti sintomi:<sup id=\"cite_ref-:0_9-5\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup><\/p>\n<ul>\n<li>Dolore o parestesie nella regione intermetatarsale, nelle dita dei piedi e nello spazio interdigitale dorsale. Il dolore peggiora in carico o utilizzando scarpe con il tacco alto. Togliere le scarpe e massaggiare delicatamente l&#8217;avampiede solitamente pu\u00f2 alleviare il dolore.<\/li>\n<li>Il dolore di solito \u00e8 acuto e pu\u00f2 diventare debilitante al punto che il paziente ha paura o ansia di camminare o addirittura di mettere il piede a terra.<sup id=\"cite_ref-:5_7-8\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup><\/li>\n<li>Il paziente potrebbe lamentare una sensazione di bruciore negli spazi intermetatarsali.<sup id=\"cite_ref-:11_11-0\" class=\"reference\"><a href=\"#cite_note-:11-11\">(11)<\/a><\/sup><\/li>\n<li>\u00c8 possibile palpare una massa.<\/li>\n<li>I sintomi possono essere presenti in seguito a un trauma.<\/li>\n<li>I pazienti potrebbero descrivere un&#8217;alterazione della sensazione e riferire di sentire di avere come un &#8220;sassolino nella scarpa&#8221;.<sup id=\"cite_ref-:2_12-0\" class=\"reference\"><a href=\"#cite_note-:2-12\">(12)<\/a><\/sup><\/li>\n<li>Il dolore peggiora camminando o correndo.<sup id=\"cite_ref-:2_12-1\" class=\"reference\"><a href=\"#cite_note-:2-12\">(12)<\/a><\/sup><\/li>\n<\/ul>\n<p>La presenza di un <a title=\"Hallux Valgus\" href=\"\/Hallux_Valgus\">alluce valgo<\/a> \u00e8 considerata un fattore predisponente allo sviluppo del neuroma di Morton.<sup id=\"cite_ref-:2_12-2\" class=\"reference\"><a href=\"#cite_note-:2-12\">(12)<\/a><\/sup><\/p>\n<h2><span id=\"Diagnostic_Tests\" class=\"mw-headline\">Test diagnostici<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Diagnostic Tests\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=8\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Diagnostic Tests\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=8\">modifica sorgente<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<ul>\n<li><a title=\"Metatarsal Squeeze Test\" href=\"\/Metatarsal_Squeeze_Test\">Test di compressione dello spazio interdigitale<\/a> (noto anche come test di compressione metatarsale): Il clinico afferra gli aspetti mediale e laterale dell&#8217;avampiede del paziente e li comprime con una mano mentre con l&#8217;altra palpa l&#8217;area dolente. L&#8217;aggravamento del dolore indica un test positivo.<\/li>\n<li>Segno di Mulder: un clic doloroso e palpabile<sup id=\"cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\">(13)<\/a><\/sup> che si verifica quando si preme e si sfrega un neuroma tra le teste metatarsali<\/li>\n<li>Test di allungamento del nervo digitale<sup id=\"cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\">(14)<\/a><\/sup>: Il clinico mantiene passivamente entrambe le caviglie in flessione dorsale completa mentre estende le dita posteriori dello spazio interdigitale sospetto. Il test \u00e8 positivo se il paziente lamenta un fastidio nello spazio interdigitale del piede interessato.<\/li>\n<\/ul>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 308px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 300px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/yJ7LUCCmFAU?\" width=\"300\" height=\"169\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\">(15)<\/a><\/sup><\/p>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Morton%27s-MRI.png\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/8\/87\/Morton%27s-MRI.png\/300px-Morton%27s-MRI.png\" srcset=\"https:\/\/www.physio-pedia.com\/images\/8\/87\/Morton%27s-MRI.png 1.5x\" alt=\"\" width=\"300\" height=\"239\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Risonanza magnetica del neuroma di Morton<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Morton%27s-Xray.png\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/2\/25\/Morton%27s-Xray.png\/300px-Morton%27s-Xray.png\" srcset=\"https:\/\/www.physio-pedia.com\/images\/2\/25\/Morton%27s-Xray.png 1.5x\" alt=\"\" width=\"300\" height=\"216\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Radiografia del neuroma di Morton<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Morton%27s-US.png\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/a\/a3\/Morton%27s-US.png\/300px-Morton%27s-US.png\" srcset=\"https:\/\/www.physio-pedia.com\/images\/a\/a3\/Morton%27s-US.png 1.5x\" alt=\"\" width=\"300\" height=\"264\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Ecografia del neuroma di Morton<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h2><span id=\"Diagnostic_Procedures\" class=\"mw-headline\">Procedure diagnostiche<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Diagnostic Procedures\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=9\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Diagnostic Procedures\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=9\">modifica sorgente<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<ul>\n<li>Ecografia (US): elevata accuratezza diagnostica. La diagnosi corretta dipende dalla tecnica e dall&#8217;esperienza di chi esegue il test.<sup id=\"cite_ref-:5_7-9\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup><sup id=\"cite_ref-:1_10-1\" class=\"reference\"><a href=\"#cite_note-:1-10\">(10)<\/a><\/sup><\/li>\n<li>Risonanza magnetica (RM): l&#8217;indagine gold standard per identificare un neuroma.<sup id=\"cite_ref-:2_12-3\" class=\"reference\"><a href=\"#cite_note-:2-12\">(12)<\/a><\/sup> Le indicazioni principali per la risonanza magnetica sono una valutazione clinica poco chiara e i casi in cui sono interessati molteplici spazi intermetatarsali.<sup id=\"cite_ref-:5_7-10\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup><\/li>\n<li>Radiografia: essenziale come approccio di imaging di prima linea per escludere la rigidit\u00e0 dell&#8217;articolazione tarso-metatarsale, l&#8217;ipermetria metatarsale, la malattia di Frieberg, le deformit\u00e0 dell&#8217;alluce e le instabilit\u00e0 metatarso-falangee (MTP).<\/li>\n<\/ul>\n<h2><span id=\"Differential_Diagnosis\" class=\"mw-headline\">Diagnosi differenziale<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Differential Diagnosis\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=10\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Differential Diagnosis\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=10\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>La diagnosi differenziale comprende le seguenti condizioni:<sup id=\"cite_ref-:0_9-6\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup><\/p>\n<ul>\n<li>Borsite intermetatarsale<\/li>\n<li>Neuroma vero<\/li>\n<li>Artrite infiammatoria<\/li>\n<li><a title=\"Pigmeted Villonodular Synovitis\" href=\"\/Pigmeted_Villonodular_Synovitis\">Sinovite villonodulare pigmentata<\/a><\/li>\n<li><a title=\"Osteomielite\" href=\"\/Osteomyelitis\">Osteomielite<\/a><\/li>\n<li>Granuloma da corpo estraneo<\/li>\n<li><a title=\"Stress Fractures\" href=\"\/Stress_Fractures\">Frattura da stress<\/a><\/li>\n<li>Infrazione di Freiberg<\/li>\n<li>Lussazione dell&#8217;articolazione metatarso-falangea<\/li>\n<\/ul>\n<h2><span id=\"Physiotherapy_Management_\/_Interventions\"><\/span><span id=\"Physiotherapy_Management_.2F_Interventions\" class=\"mw-headline\">Gestione fisioterapica \/ Interventi<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Physiotherapy Management \/ Interventions\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=11\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Physiotherapy Management \/ Interventions\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=11\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<h3><span id=\"Footwear\" class=\"mw-headline\">Calzature<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Footwear\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=12\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Footwear\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=12\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Obiettivo: limitare la compressione nervosa nelle fasi iniziali del neuroma di Morton.<\/p>\n<p>Strumenti: educazione del paziente, modifica delle calzature.<\/p>\n<blockquote><p>Secondo Col\u00f2 et al.,<sup id=\"cite_ref-:5_7-11\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup> se un individuo \u00e8 oltre i 4,5 mesi dalla diagnosi e il neuroma \u00e8 pi\u00f9 grande di 5-6 mm, le ortesi e\/o le modifiche alle scarpe non sono pi\u00f9 efficaci per la gestione dei sintomi. In questa fase, offrono una soluzione palliativa per ottenere una<i>&#8220;vita accettabile con il dolore<\/i>&#8220;.<sup id=\"cite_ref-:5_7-12\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup><\/p><\/blockquote>\n<h4><span id=\"Patient_Education\" class=\"mw-headline\">Educazione del paziente<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Patient Education\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=13\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Patient Education\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=13\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Il paziente dovrebbe essere istruito su:<\/p>\n<ul>\n<li>Evitare scarpe strette e con il tacco alto<\/li>\n<li>Rimanere conformi con la prescrizione delle calzature<\/li>\n<li>Modifica delle attivit\u00e0<sup id=\"cite_ref-:13_16-0\" class=\"reference\"><a href=\"#cite_note-:13-16\">(16)<\/a><\/sup><\/li>\n<\/ul>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Rocker_sole_shoe.jpeg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/b\/b1\/Rocker_sole_shoe.jpeg\/300px-Rocker_sole_shoe.jpeg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/b\/b1\/Rocker_sole_shoe.jpeg 1.5x\" alt=\"\" width=\"300\" height=\"301\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Scarpa con suola Rocker<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h4><span id=\"Footwear_Modification\" class=\"mw-headline\">Modifica delle calzature<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Footwear Modification\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=14\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Footwear Modification\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=14\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Le calzature pi\u00f9 adatte presentano le seguenti caratteristiche:<sup id=\"cite_ref-:5_7-13\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup><sup id=\"cite_ref-:3_17-0\" class=\"reference\"><a href=\"#cite_note-:3-17\">(17)<\/a><\/sup><\/p>\n<ul>\n<li>Lunghezza sufficiente<sup id=\"cite_ref-:5_7-14\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup><\/li>\n<li>Punta ampia<sup id=\"cite_ref-:5_7-15\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup><\/li>\n<li>Tacco basso<sup id=\"cite_ref-:5_7-16\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup><\/li>\n<li>Suola esterna spessa, che non dovrebbe essere eccessivamente flessibile<sup id=\"cite_ref-:5_7-17\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup><\/li>\n<li>Imbottitura metatarsale<sup id=\"cite_ref-:3_17-1\" class=\"reference\"><a href=\"#cite_note-:3-17\">(17)<\/a><\/sup><\/li>\n<li>Una suola inferiore di tipo &#8220;rocker&#8221; potrebbe essere utile<sup id=\"cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\">(18)<\/a><\/sup><\/li>\n<\/ul>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Metatarsal_Pad_-_Shutterstock_Image_-_ID_1603933129.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/9\/93\/Metatarsal_Pad_-_Shutterstock_Image_-_ID_1603933129.jpg\/300px-Metatarsal_Pad_-_Shutterstock_Image_-_ID_1603933129.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/9\/93\/Metatarsal_Pad_-_Shutterstock_Image_-_ID_1603933129.jpg\/450px-Metatarsal_Pad_-_Shutterstock_Image_-_ID_1603933129.jpg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/9\/93\/Metatarsal_Pad_-_Shutterstock_Image_-_ID_1603933129.jpg\/600px-Metatarsal_Pad_-_Shutterstock_Image_-_ID_1603933129.jpg 2x\" alt=\"\" width=\"300\" height=\"300\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Cuscinetto metatarsale<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h3><span id=\"Orthotics\" class=\"mw-headline\">Ortesi<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Orthotics\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=15\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Orthotics\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=15\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Obiettivi:<\/p>\n<ol>\n<li>Per distribuire i siti di pressione<\/li>\n<li>Per alleviare il dolore<\/li>\n<\/ol>\n<ul>\n<li>L&#8217;ortesi pi\u00f9 comunemente fornita inizialmente \u00e8 <b>la barra metatarsale<\/b>. Il suo obiettivo \u00e8 quello di:\n<ul>\n<li>Allargare le teste dei metatarsi per alleviare la pressione<\/li>\n<li>Migliorare i sintomi<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>L&#8217;evidenza di un miglioramento degli outcome riferiti dal paziente con l&#8217;uso di <i>solette per l&#8217;inversione o l&#8217;eversione<\/i> (cuneo per piede varo\/valgo) \u00e8 limitata o nulla.<sup id=\"cite_ref-:2_12-4\" class=\"reference\"><a href=\"#cite_note-:2-12\">(12)<\/a><\/sup><\/li>\n<\/ul>\n<ul>\n<li>Secondo de Oliveira et al.,<sup id=\"cite_ref-:12_19-0\" class=\"reference\"><a href=\"#cite_note-:12-19\">(19)<\/a><\/sup> una <b>soletta personalizzata con supporto metatarsale e dell&#8217;arco plantare<\/b> offre sollievo dal dolore durante la deambulazione e migliora la funzionalit\u00e0.<\/li>\n<li>Quando \u00e8 presente una deformit\u00e0 del piede ad artiglio si possono aggiungere <b>inserti su misura<\/b> in gomma siliconica.<sup id=\"cite_ref-:0_9-7\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup><\/li>\n<li><b>Ortesi su misura realizzate con metodologie di impronta in gommapiuma<\/b>. Il piede viene posizionato con l&#8217;articolazione tibio-tarsica in posizione neutra, con una volta longitudinale prolungata per sostenere il primo metatarso (appoggio piatto). L&#8217;obiettivo \u00e8 quello di imitare lo schema fisiologico dell&#8217;appoggio del peso corporeo sul metatarso, da laterale a mediale, prima che la pressione si sposti sull&#8217;alluce.<sup id=\"cite_ref-:5_7-18\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup><\/li>\n<\/ul>\n<h3><span id=\"Steroid_Injections\" class=\"mw-headline\">Iniezioni di steroidi<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Steroid Injections\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=16\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Steroid Injections\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=16\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Obiettivo: fornire sollievo dal dolore.<\/p>\n<p>Le iniezioni di steroidi sono abbastanza standard nella gestione del neuroma di Morton. Il metodo di iniezione varia: pu\u00f2 essere ecoguidato o eseguito utilizzando una tecnica con un punto di riferimento.<\/p>\n<ul>\n<li>Uno studio randomizzato controllato di Mahadevan et al.<sup id=\"cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\">(20)<\/a><\/sup> non ha rilevato alcuna differenza statistica negli outcome dei pazienti dopo un&#8217;iniezione di steroidi ecoguidata rispetto a un&#8217;iniezione non ecoguidata.<\/li>\n<li>Choi et al.<sup id=\"cite_ref-:15_21-0\" class=\"reference\"><a href=\"#cite_note-:15-21\">(21)<\/a><\/sup> hanno dimostrato che c&#8217;era un &#8220;outcome clinico soddisfacente&#8221;<sup id=\"cite_ref-:15_21-1\" class=\"reference\"><a href=\"#cite_note-:15-21\">(21)<\/a><\/sup> in termini di riduzione del dolore nei pazienti dopo le iniezioni di corticosteroidi, ma il 30% dei pazienti alla fine ha richiesto un intervento chirurgico per la gestione del dolore.<\/li>\n<li>Lizano-Diez et al.<sup id=\"cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\">(22)<\/a><\/sup> non hanno riscontrato alcuna differenza in termini di dolore e funzione nei partecipanti che hanno ricevuto un&#8217;iniezione di un corticosteroide pi\u00f9 un anestetico locale rispetto a quelli che hanno ricevuto solo un anestetico locale.<\/li>\n<\/ul>\n<h3><span id=\"Modality\" class=\"mw-headline\">Modalit\u00e0<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Modality\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=17\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Modality\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=17\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<ul>\n<li>La <a title=\"Extracorporeal Shockwave Therapy (ESWT)\" href=\"\/Extracorporeal_Shockwave_Therapy_(ESWT)\">terapia ad onde d&#8217;urto extracorporee (ESWT)<\/a><sup id=\"cite_ref-:4_23-0\" class=\"reference\"><a href=\"#cite_note-:4-23\">(23)<\/a><\/sup> potrebbe ridurre il dolore nei pazienti con neuroma di Morton.<sup id=\"cite_ref-:4_23-1\" class=\"reference\"><a href=\"#cite_note-:4-23\">(23)<\/a><\/sup><\/li>\n<li>La <a title=\"Transcutaneous Electrical Nerve Stimulation (TENS)\" href=\"\/Transcutaneous_Electrical_Nerve_Stimulation_(TENS)\">stimolazione elettrica transcutanea (TENS)<\/a> pu\u00f2 aiutare a gestire il dolore.<sup id=\"cite_ref-:13_16-1\" class=\"reference\"><a href=\"#cite_note-:13-16\">(16)<\/a><\/sup><\/li>\n<\/ul>\n<h3><span id=\"Manipulation\/Mobilisation\"><\/span><span id=\"Manipulation.2FMobilisation\" class=\"mw-headline\">Manipolazione \/ Mobilizzazione<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Manipulation\/Mobilisation\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=18\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Manipulation\/Mobilisation\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=18\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Secondo Cashley e Cochrane,<sup id=\"cite_ref-:14_24-0\" class=\"reference\"><a href=\"#cite_note-:14-24\">(24)<\/a><\/sup> la manipolazione del piede e la mobilizzazione delle altre articolazioni del piede e della caviglia possono ridurre il dolore al piede nei pazienti con diagnosi di nevralgia digitale plantare (neuroma di Morton). Gli autori raccomandano di eseguire la manipolazione articolare una volta alla settimana per quattro settimane, seguita da altre due visite a intervalli di 14 giorni.<sup id=\"cite_ref-:14_24-1\" class=\"reference\"><a href=\"#cite_note-:14-24\">(24)<\/a><\/sup><\/p>\n<h3><span id=\"Strengthening_Exercises\" class=\"mw-headline\">Esercizi di rinforzo<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Strengthening Exercises\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=19\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Strengthening Exercises\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=19\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Secondo Helene Simpson,<sup id=\"cite_ref-:13_16-2\" class=\"reference\"><a href=\"#cite_note-:13-16\">(16)<\/a><\/sup> gli esercizi di rinforzo dei flessori delle dita e degli intrinseci possono favorire l&#8217;attivazione muscolare durante la fase di appoggio intermedia (mid-stance) del ciclo del passo e prevenire il collasso delle teste metatarsali.<\/p>\n<h2><span id=\"Other_Treatment_Options\" class=\"mw-headline\">Altre opzioni di trattamento<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Other Treatment Options\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=20\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Other Treatment Options\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=20\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>L&#8217;intervento chirurgico viene preso in considerazione quando il trattamento conservativo fallisce o il paziente non \u00e8 pi\u00f9 disposto a modificare il proprio stile di vita per gestire i sintomi del neuroma di Morton. Sono disponibili le seguenti opzioni di trattamento operativo e non operativo:<\/p>\n<ul>\n<li>Escissione chirurgica del nervo (neurectomia)<sup id=\"cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\">(25)<\/a><\/sup><\/li>\n<li>Decompressione chirurgica del nervo<sup id=\"cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\">(26)<\/a><\/sup><\/li>\n<li>Radiofrequenza percutanea ecoguidata<\/li>\n<li>Iniezione di alcol<\/li>\n<li>Alcolizzazione percutanea guidata dall&#8217;elettrostimolazione con fenolo<sup id=\"cite_ref-:0_9-8\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup><\/li>\n<\/ul>\n<h2><span id=\"Resources\" class=\"mw-headline\">Risorse<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Resources\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=21\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Resources\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=21\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<ol>\n<li><a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6375221\/pdf\/13047_2019_Article_320.pdf\" rel=\"nofollow\">The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Morton\u2019s neuroma): a systematic review and meta-analysis<\/a><\/li>\n<li><a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7944831\/pdf\/ACTA-91-60.pdf\" rel=\"nofollow\">The effectiveness of shoe modifications and orthotics in the conservative treatment of Civinini-Morton syndrome: state of the art<\/a><\/li>\n<li><a class=\"external text\" href=\"https:\/\/www.ajronline.org\/doi\/epdf\/10.2214\/AJR.16.17276\" rel=\"nofollow\">Second and Third Metatarsophalangeal Plantar Plate Tears: Diagnostic Performance of Direct and Indirect MRI Features Using Surgical Findings as the Reference Standard<\/a><\/li>\n<\/ol>\n<h2><span id=\"References\" class=\"mw-headline\">Citazioni<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: References\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;veaction=edit&amp;section=22\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: References\" href=\"\/index.php?title=Physiotherapy_for_Morton%27s_Neuroma&amp;action=edit&amp;section=22\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<div class=\"mw-references-wrap mw-references-columns\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-1\">\u2191<\/a><\/span> <span class=\"reference-text\">Weinfeld SB, Myerson MS. Interdigital Neuritis: Diagnosis and Treatment. J Am Acad Orthop Surg. 1996 Nov;4(6):328-335.<\/span><\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-2\">\u2191<\/a><\/span> <span class=\"reference-text\">Riddick DA, Riddick DH, Jorge M. 7 &#8211; Footwear: foundation for lower extremity orthoses. In: Chui KK, Jorge M, Yen S-C, Lusardi MM, editors. Orthotics and prosthetics in rehabilitation (Fourth Edition). Elsevier, 2020. p164-82.<\/span><\/li>\n<li id=\"cite_note-:10-3\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:10_3-0\">3.0<\/a><\/sup> <sup><a href=\"#cite_ref-:10_3-1\">3.1<\/a><\/sup> <sup><a href=\"#cite_ref-:10_3-2\">3.2<\/a><\/sup> <sup><a href=\"#cite_ref-:10_3-3\">3.3<\/a><\/sup><\/span> <span class=\"reference-text\">Jain S, Mannan K. The diagnosis and management of Morton&#8217;s neuroma: a literature review. Foot Ankle Spec. 2013 Aug;6(4):307-17.<\/span><\/li>\n<li id=\"cite_note-:7-4\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-:7_4-0\">\u2191<\/a><\/span> <span class=\"reference-text\">Govsa F, Bilge O, Ozer MA. Anatomical study of the communicating branches between the medial and lateral plantar nerves. Surgical and Radiologic Anatomy. 2005 Dec;27(5):377-81.<\/span><\/li>\n<li id=\"cite_note-:8-5\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:8_5-0\">5.0<\/a><\/sup> <sup><a href=\"#cite_ref-:8_5-1\">5.1<\/a><\/sup><\/span> <span class=\"reference-text\">Torres AL, Ferreira MC. <a class=\"external text\" href=\"https:\/\/www.scielo.br\/j\/aob\/a\/3PgtjmSVwWMDmCYZgbPhghq\/?format=pdf&amp;lang=en\" rel=\"nofollow\">Study of the anatomy of the tibial nerve and its branches in the distal medial leg<\/a>. Acta ortopedica brasileira. 2012;20:157-64.<\/span><\/li>\n<li id=\"cite_note-:9-6\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-:9_6-0\">\u2191<\/a><\/span> <span class=\"reference-text\">Koo GB, Lee JH, Jang JH, Song IH, Kim JY. Superficial course of the medial plantar nerve: case report. Anatomy &amp; cell biology. 2019 Mar 1;52(1):87-9.<\/span><\/li>\n<li id=\"cite_note-:5-7\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:5_7-0\">7.00<\/a><\/sup> <sup><a href=\"#cite_ref-:5_7-1\">7.01<\/a><\/sup> <sup><a href=\"#cite_ref-:5_7-2\">7.02<\/a><\/sup> <sup><a href=\"#cite_ref-:5_7-3\">7.03<\/a><\/sup> <sup><a href=\"#cite_ref-:5_7-4\">7.04<\/a><\/sup> <sup><a href=\"#cite_ref-:5_7-5\">7.05<\/a><\/sup> <sup><a href=\"#cite_ref-:5_7-6\">7.06<\/a><\/sup> <sup><a href=\"#cite_ref-:5_7-7\">7.07<\/a><\/sup> <sup><a href=\"#cite_ref-:5_7-8\">7.08<\/a><\/sup> <sup><a href=\"#cite_ref-:5_7-9\">7.09<\/a><\/sup> <sup><a href=\"#cite_ref-:5_7-10\">7.10<\/a><\/sup> <sup><a href=\"#cite_ref-:5_7-11\">7.11<\/a><\/sup> <sup><a href=\"#cite_ref-:5_7-12\">7.12<\/a><\/sup> <sup><a href=\"#cite_ref-:5_7-13\">7.13<\/a><\/sup> <sup><a href=\"#cite_ref-:5_7-14\">7.14<\/a><\/sup> <sup><a href=\"#cite_ref-:5_7-15\">7.15<\/a><\/sup> <sup><a href=\"#cite_ref-:5_7-16\">7.16<\/a><\/sup> <sup><a href=\"#cite_ref-:5_7-17\">7.17<\/a><\/sup> <sup><a href=\"#cite_ref-:5_7-18\">7.18<\/a><\/sup><\/span> <span class=\"reference-text\">Col\u00f2 G, Rava A, Samaila EM, Palazzolo A, Talesa G, Schiraldi M, Magnan B, Ferracini R, Felli L. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7944831\/pdf\/ACTA-91-60.pdf\" rel=\"nofollow\">The effectiveness of shoe modifications and orthotics in the conservative treatment of Civinini-Morton syndrome: state of the art.<\/a> Acta Biomed. 2020 May 30;91(4-S):60-68.<\/span><\/li>\n<li id=\"cite_note-:6-8\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:6_8-0\">8.0<\/a><\/sup> <sup><a href=\"#cite_ref-:6_8-1\">8.1<\/a><\/sup> <sup><a href=\"#cite_ref-:6_8-2\">8.2<\/a><\/sup><\/span> <span class=\"reference-text\">Hassouna H, Singh D. Morton&#8217;s metatarsalgia: pathogenesis, aetiology and current management. Acta Orthop Belg. 2005 Dec;71(6):646-55. <\/span><\/li>\n<li id=\"cite_note-:0-9\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:0_9-0\">9.0<\/a><\/sup> <sup><a href=\"#cite_ref-:0_9-1\">9.1<\/a><\/sup> <sup><a href=\"#cite_ref-:0_9-2\">9.2<\/a><\/sup> <sup><a href=\"#cite_ref-:0_9-3\">9.3<\/a><\/sup> <sup><a href=\"#cite_ref-:0_9-4\">9.4<\/a><\/sup> <sup><a href=\"#cite_ref-:0_9-5\">9.5<\/a><\/sup> <sup><a href=\"#cite_ref-:0_9-6\">9.6<\/a><\/sup> <sup><a href=\"#cite_ref-:0_9-7\">9.7<\/a><\/sup> <sup><a href=\"#cite_ref-:0_9-8\">9.8<\/a><\/sup><\/span> <span class=\"reference-text\">Bencardino J, Rosenberg ZS, Beltran J, Liu X, Marty-Delfaut E. <a class=\"external text\" href=\"https:\/\/www.ajronline.org\/doi\/epdf\/10.2214\/ajr.175.3.1750649\" rel=\"nofollow\">Morton&#8217;s neuroma: is it always symptomatic?<\/a>. American journal of roentgenology. 2000 Sep;175(3):649-53.<\/span><\/li>\n<li id=\"cite_note-:1-10\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:1_10-0\">10.0<\/a><\/sup> <sup><a href=\"#cite_ref-:1_10-1\">10.1<\/a><\/sup><\/span> <span class=\"reference-text\">Mak MS, Chowdhury R, Johnson R. Morton&#8217;s neuroma: a review of anatomy, pathomechanism, and imaging. Clinical Radiology. 2021 Mar 1;76(3):235-e15.<\/span><\/li>\n<li id=\"cite_note-:11-11\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-:11_11-0\">\u2191<\/a><\/span> <span class=\"reference-text\">Mahadevan D, Venkatesan M, Bhatt R, Bhatia M. Diagnostic Accuracy of Clinical Tests for Morton&#8217;s Neuroma Compared With Ultrasonography. J Foot Ankle Surg. 2015 Jul-Aug;54(4):549-53. <\/span><\/li>\n<li id=\"cite_note-:2-12\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:2_12-0\">12.0<\/a><\/sup> <sup><a href=\"#cite_ref-:2_12-1\">12.1<\/a><\/sup> <sup><a href=\"#cite_ref-:2_12-2\">12.2<\/a><\/sup> <sup><a href=\"#cite_ref-:2_12-3\">12.3<\/a><\/sup> <sup><a href=\"#cite_ref-:2_12-4\">12.4<\/a><\/sup><\/span> <span class=\"reference-text\">Bhatia M, Thomson L. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7211826\/\" rel=\"nofollow\">Morton\u2019s neuroma\u2013current concepts review<\/a>. Journal of Clinical Orthopaedics and Trauma. 2020 May 1;11(3):406-9.<\/span><\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-13\">\u2191<\/a><\/span> <span class=\"reference-text\">Skalina T, Weerakkody Y. Mulder sign. Reference article, Radiopaedia.org. Available from <a class=\"external free\" href=\"https:\/\/radiopaedia.org\/articles\/mulder-sign\" rel=\"nofollow\">https:\/\/radiopaedia.org\/articles\/mulder-sign<\/a> (accessed on 14 Oct 2022) <\/span><\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-14\">\u2191<\/a><\/span> <span class=\"reference-text\">Cashley DG, Cochrane L. Manipulation in the Treatment of Plantar Digital Neuralgia: A Retrospective Study of 38 Cases. J Chiropr Med. 2015 Jun;14(2):90-8<\/span><\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-15\">\u2191<\/a><\/span> <span class=\"reference-text\">The Physio Channel. Metatarsal Squeeze Test for Mortons Neuroma and Mulders Sign. 2019. Available from: <a class=\"external free\" href=\"https:\/\/www.youtube.com\/watch?v=yJ7LUCCmFAU\" rel=\"nofollow\">https:\/\/www.youtube.com\/watch?v=yJ7LUCCmFAU<\/a>(last accessed 15\/10\/2022)<\/span><\/li>\n<li id=\"cite_note-:13-16\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:13_16-0\">16.0<\/a><\/sup> <sup><a href=\"#cite_ref-:13_16-1\">16.1<\/a><\/sup> <sup><a href=\"#cite_ref-:13_16-2\">16.2<\/a><\/sup><\/span> <span class=\"reference-text\">Simpson H. Morton&#8217;s Neuroma Course. Plus 2022<\/span><\/li>\n<li id=\"cite_note-:3-17\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:3_17-0\">17.0<\/a><\/sup> <sup><a href=\"#cite_ref-:3_17-1\">17.1<\/a><\/sup><\/span> <span class=\"reference-text\">Matthews BG, Hurn SE, Harding MP, Henry RA, Ware RS. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6375221\/pdf\/13047_2019_Article_320.pdf\" rel=\"nofollow\">The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Morton&#8217;s neuroma): a systematic review and meta-analysis<\/a>. J Foot Ankle Res. 2019 Feb 13;12:12<\/span><\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-18\">\u2191<\/a><\/span> <span class=\"reference-text\">Janisse DJ, Janisse E. Shoe modification and the use of orthoses in treating foot and ankle pathology. J Am Acad Orthop Surg. 2008 Mar;16(3):152-8. <\/span><\/li>\n<li id=\"cite_note-:12-19\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-:12_19-0\">\u2191<\/a><\/span> <span class=\"reference-text\">de Oliveira HAV, Natour J, Vassalli M, Rosenfeld A, Jennings F, Jones A. Effectiveness of customized insoles in patients with Morton&#8217;s neuroma: a randomized, controlled, double-blind clinical trial. Clin Rehabil. 2019 Dec;33(12):1898-1907. <\/span><\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-20\">\u2191<\/a><\/span> <span class=\"reference-text\">Mahadevan D, Attwal M, Bhatt R, Bhatia M. <a class=\"external text\" href=\"https:\/\/online.boneandjoint.org.uk\/doi\/pdf\/10.1302\/0301-620X.98B4.36880\" rel=\"nofollow\">Corticosteroid injection for Morton&#8217;s neuroma with or without ultrasound guidance: a randomised controlled trial<\/a>. Bone Joint J. 2016 Apr;98-B(4):498-503.<\/span><\/li>\n<li id=\"cite_note-:15-21\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:15_21-0\">21.0<\/a><\/sup> <sup><a href=\"#cite_ref-:15_21-1\">21.1<\/a><\/sup><\/span> <span class=\"reference-text\">Choi JY, Lee HI, Hong WH, Suh JS, Hur JW. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8173242\/pdf\/cios-13-266.pdf\" rel=\"nofollow\">Corticosteroid Injection for Morton&#8217;s Interdigital Neuroma: A Systematic Review.<\/a> Clin Orthop Surg. 2021 Jun;13(2):266-277.<\/span><\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-22\">\u2191<\/a><\/span> <span class=\"reference-text\">Lizano-D\u00edez X, Gin\u00e9s-Cespedosa A, Alentorn-Geli E, P\u00e9rez-Prieto D, Gonz\u00e1lez-Lucena G, Gamba C, de Zabala S, Solano-L\u00f3pez A, Rigol-Ram\u00f3n P. Corticosteroid Injection for the Treatment of Morton&#8217;s Neuroma: A Prospective, Double-Blinded, Randomized, Placebo-Controlled Trial. Foot Ankle Int. 2017 Sep;38(9):944-951.<\/span><\/li>\n<li id=\"cite_note-:4-23\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:4_23-0\">23.0<\/a><\/sup> <sup><a href=\"#cite_ref-:4_23-1\">23.1<\/a><\/sup><\/span> <span class=\"reference-text\">Seok H, Kim SH, Lee SY, Park SW. Extracorporeal Shockwave Therapy in Patients with Morton&#8217;s Neuroma A Randomized, Placebo-Controlled Trial. J Am Podiatr Med Assoc. 2016 Mar;106(2):93-9.<\/span><\/li>\n<li id=\"cite_note-:14-24\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:14_24-0\">24.0<\/a><\/sup> <sup><a href=\"#cite_ref-:14_24-1\">24.1<\/a><\/sup><\/span> <span class=\"reference-text\">Cashley DG, Cochrane L. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4523570\/pdf\/main.pdf\" rel=\"nofollow\">Manipulation in the Treatment of Plantar Digital Neuralgia: A Retrospective Study of 38 Cases<\/a>. J Chiropr Med. 2015 Jun;14(2):90-8.<\/span><\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-25\">\u2191<\/a><\/span> <span class=\"reference-text\">Samaila EM, Ambrosini C, Negri S, Maluta T, Valentini R, Magnan B. Can percutaneous alcoholization of Morton&#8217;s neuroma with phenol by electrostimulation guidance be an alternative to surgical excision? Long-term results. Foot Ankle Surg. 2020 Apr;26(3):314-319.<\/span><\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-26\">\u2191<\/a><\/span> <span class=\"reference-text\">Jain S, Mannan K. The diagnosis and management of Morton\u2019s neuroma: a literature review. Foot &amp; Ankle Specialist. 2013 Aug;6(4):307-17.<\/span><\/li>\n<\/ol>\n<\/div>\n<p><!-- NewPP limit report Cached time: 20230123162610 Cache expiry: 0 Dynamic content: true Complications: () CPU time usage: 0.160 seconds Real time usage: 0.175 seconds Preprocessor visited node count: 624\/1000000 Post\u2010expand include size: 91\/2097152 bytes Template argument size: 0\/2097152 bytes Highest expansion depth: 3\/40 Expensive parser function count: 0\/100 Unstrip recursion depth: 0\/20 Unstrip post\u2010expand size: 18474\/5000000 bytes --><br \/>\n<!-- Transclusion expansion time report (%,ms,calls,template) 100.00% 8.585 1 Special:Contributors\/Physiotherapy_for_Morton's_Neuroma 100.00% 8.585 1 -total --><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Editrice principale &#8211; Ewa Jaraczewska Collaboratori principali &#8211; Ewa Jaraczewska e Jess Bell Contenuti 1 Introduzione 2 Anatomia clinicamente rilevante 2.1 Neuroma 3 Eziologia 3.1 Epidemiologia 4 Meccanismo di lesione \/ Processo patologico 5 Presentazione clinica 6 Test diagnostici 7 Procedure diagnostiche 8 Diagnosi differenziale 9 Gestione fisioterapica \/ Interventi 9.1 Calzature 9.1.1 Educazione del [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-4808","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages\/4808","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/comments?post=4808"}],"version-history":[{"count":1,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages\/4808\/revisions"}],"predecessor-version":[{"id":4811,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages\/4808\/revisions\/4811"}],"wp:attachment":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/media?parent=4808"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}