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On This Day   January-04  (Benjamin Rush -1746 AD)

Benjamin Rush was one of the major political leaders who participated in the American Revolution and signed the U.S. Declaration of Independence in 1776 who insisted in medical freedom as in religious freedom but was not successful making it an article of the constitution...

 
 
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MORTON'S DISEASE
This is another name for metatarsalgia, a neuralgic pain shooting from the ball of the foot into the toes.
The heads of the five metatarsal bones are normally arranged in the form of an arch convex upwards and passing from one side of the foot to the other; the arch flattens out when the weight of the body passes from the heel to the front of the foot as in walking. Normally the metatarsal bone of the fifth or little toe, and the corresponding bone of the first or great toe -the inner and outer piers of the arch- carry the greatest part of the weight, the inner pier -the ball of the great toe receiving a final thrust aginst the ground as we step forward.

 
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Smokh   MORTON'S DISASE: PLANTAR NERVES
Pressure by the heads of the metatarsal bones on branches of the plantar nerves is the cause of the severe neuralgia known as metatasalgia, or Morton’s disease. The course of these nerves is shown. Right, a section through the heads of these bones, showing the nerves which may be pressed on if the arch drops.

The essential cause of Morton's disease is a flatening of this arch. The weight of the body, instead of being borne mainly by the first and fifth metatarsals falls unduly upon the middle members of the series, usually the third or fourth, for the second is protected by its nearness to the first, the largest and strongest of the five.

In most people approaching middle age, there is some dropping of the transverse arch of the foot, indicated by a thickening of the skin under the middle of the front of the foot. Often a painful corn develops in this spot, and this may be the only inconvcnience.
In Morton's disease, however, there is a severe burning pain shooting into the third or fonrth toes, which as a rule is only experienced when walking in ordinary boots or shoes; the patient may be able to walk in slippers or bare feet without pain. The nerves that pass into the toes reach their destination by passing between the heads of the metatarsal bones; when the arch is depressed they may be compressed either between the heads of the bones or between the latter and the ground.
The disease is much commoner in women than in men, for the reason that many women wear boots or shoes the soles of which are actually narrower than the feet, hence the outer and inner pillars of the arch rest partly upon the upper of the boot. The head of the fifth metatarsal is lifted up and the head of the fourth takes its place as a weight-bearer.
Treatment
The treatment depends upon restoration of the transverse arch by boots having adequate width of sole across the ball of the foot, room for movements of the toes, and low, broad heels. If the arch can be restored by manipulation it is often an advantage to bind a strip of sticking-plaster firmly around the front part of the foot. This acts like a tie-beam, drawing the pieces of the arch together and so pressing the heads of the fourth and fifth metatarsals upwards into their proper place.
Toe exercises are helpful. The patient should practise bending the toes, going through an action as if trying to make a fist with his foot. Lifting up the toes flattens this arch; bending them restores it.
If the arch cannot be restored by manipulation, spccial boots prescribed by an orthopaedic surgeon to meet the needs of the particular patient are essential.
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