Master’s degree University of State of Rio de Janeiro Rio de Janeiro, Rio de Janeiro, Brazil
Case Diagnosis: Morton’s neuroma is a painful forefoot condition associated with paresthesia, often worsening with weight-bearing. Lesions arise mainly from interdigital nerve compression, though ischemia or bursal compression may also contribute, and histologically show fibrosis and nerve degeneration. Imaging aids in diagnosis and localization. Treatment can be conservative or surgical. Acupuncture is a non-invasive conservative option, involving stimulation of specific points with needles or pressure. It modulates pain through activation of primary afferent fibers, improves microcirculation, and increases endogenous opioids and corticosteroids. Acupuncture may therefore benefit patients with chronic forefoot pain who are unresponsive to conventional therapies.
Case Description: A 51-year-old female presented with progressive left forefoot pain for three years, described as burning and worse with closed shoes. Previous treatments, including multiple modalities, were ineffective. Examination revealed tenderness below the left 4th toe (VAS = 8/10), positive Mulder test, and pain on tiptoe but not on heels. Ultrasound showed a 7x4 mm hypoechogenic nodule between the 3rd and 4th metatarsals, suggesting Morton’s neuroma. Ten weekly acupuncture sessions were performed at points ST42, ST44, and GB41. After completion, pain decreased (VAS = 3/10) and Mulder test became negative. Sessions were later spaced biweekly and monthly, with the patient maintaining minimal to no pain.
Discussions: Acupuncture points induce activation of high-density primary afferent fibers, including myelinated A fibers and unmyelinated C fibers. This stimulation enhances microcirculation and triggers release of endogenous opioids and corticosteroids, contributing to analgesia. These mechanisms make acupuncture a promising conservative option for patients with neuroma-related pain refractory to standard treatments.
Conclusions: This case demonstrates that acupuncture can effectively reduce pain in Morton’s neuroma. Further clinical studies are needed to confirm efficacy and to establish standardized treatment protocols.
