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Radiologic Clinics of North America Nov 2018Although causes of metatarsalgia are multifactorial, in practice these most commonly include osseous stress reaction or fracture (including subchondral injury) and... (Review)
Review
Although causes of metatarsalgia are multifactorial, in practice these most commonly include osseous stress reaction or fracture (including subchondral injury) and interdigital neuroma or plantar plate tear with adjacent pseudoneuroma. The various roles of radiography, ultrasonography, and MR imaging are discussed, and relevant technical issues and imaging findings are reviewed in order to facilitate accurate diagnosis and guide proper treatment of metatarsalgia.
Topics: Athletic Injuries; Diagnosis, Differential; Fractures, Bone; Humans; Metatarsalgia; Risk Factors; Sensitivity and Specificity
PubMed: 30322488
DOI: 10.1016/j.rcl.2018.06.004 -
Radiographics : a Review Publication of... 2015The anatomy of the nerves of the foot and ankle is complex, and familiarity with the normal anatomy and course of these nerves as well as common anatomic variants is... (Review)
Review
The anatomy of the nerves of the foot and ankle is complex, and familiarity with the normal anatomy and course of these nerves as well as common anatomic variants is essential for correct identification at imaging. Ultrasonography (US) and magnetic resonance (MR) imaging allow visualization of these nerves and may facilitate diagnosis of various compression syndromes, such as "jogger's heel," Baxter neuropathy, and Morton neuroma. It may be difficult to distinguish the nerves from adjacent vasculature at MR imaging, and US can help in differentiation. The authors review the normal anatomy and common variants of the nerves of the foot and ankle, with use of dissected specimens and correlative US and MR imaging findings. In addition, the authors illustrate proper probe positioning, which is essential for visualizing the nerves at US. The authors' discussion focuses on the superficial and deep peroneal, sural, saphenous, tibial, medial and lateral plantar, medial and inferior calcaneal, common digital, and medial proper plantar digital nerves.
Topics: Ankle; Artifacts; Foot; Humans; Magnetic Resonance Imaging; Nerve Compression Syndromes; Peroneal Nerve; Sural Nerve; Tibial Nerve; Ultrasonography
PubMed: 26284303
DOI: 10.1148/rg.2015150028 -
Pain Physician May 2018Recently, clinicians have been applying pulsed radiofrequency (PRF) stimulation on various peripheral nerves to manage patients' peripheral neuropathic pain. (Review)
Review
BACKGROUND
Recently, clinicians have been applying pulsed radiofrequency (PRF) stimulation on various peripheral nerves to manage patients' peripheral neuropathic pain.
OBJECTIVES
To review the literature on the use and efficacy of PRF for controlling peripheral neuropathic pain.
STUDY DESIGN
This is a narrative review of relevant articles on the effectiveness of PRF for peripheral neuropathic pain.
METHODS
A PubMed search was conducted for papers published from January 1, 1980 to August 31, 2017 that used PRF to treat peripheral neuropathic pain. The key search phrase for identifying potentially relevant articles was [PRF AND pain]. The following inclusion criteria were applied for the selection of articles: 1) patients' pain was caused by peripheral nervous system disorders; 2) PRF stimulation was applied on the peripheral nerve; and 3) after PRF stimulation, follow-up evaluation was performed to assess the reduction in pain. Review articles were excluded.
RESULTS
A total of 468 articles were found to be potentially relevant. After reading the titles and abstracts of the papers and assessing them for eligibility based on the full-text articles, 63 publications were finally included in this review. For radicular pain from spinal diseases, the evidence supports that PRF is an effective treatment. Similarly, PRF appears to be effective for postherpetic neuralgia and occipital neuralgia. On the other hand, for trigeminal neuralgia, the results of previous studies indicate that PRF is not appropriate for managing trigeminal neuralgia and less effective than conventional RF. However, data on the use of PRF for pudendal neuralgia, meralgia paresthetica, carpal tunnel syndrome, tarsal tunnel syndrome, and Morton's neuroma, is lacking and thus the efficacy of PRF in these peripheral nerve disorders cannot be determined at this time.
LIMITATIONS
This review did not include studies indexed in databases other than PubMed.
CONCLUSIONS
This review will help guide clinicians in making informed decisions regarding whether PRF is the appropriate option for managing the various peripheral neuropathic pain conditions in their patients.
KEY WORDS
Pulsed radiofrequency, peripheral neuropathic pain, radicular pain, postherpetic neuralgia, trigeminal neuralgia, occipital neuralgia, pudendal neuralgia, meralgia, carpal tunnel syndrome, review.
Topics: Female; Humans; Male; Neuralgia; Pain Management; Pulsed Radiofrequency Treatment; Treatment Outcome
PubMed: 29871378
DOI: No ID Found -
Journal of Foot and Ankle Research 2019Morton's neuroma (MN) is a compressive neuropathy of the common plantar digital nerve. It is a common compressive neuropathy often causing significant pain which limits... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Morton's neuroma (MN) is a compressive neuropathy of the common plantar digital nerve. It is a common compressive neuropathy often causing significant pain which limits footwear choices and weight bearing activities. This paper aims to review non-surgical interventions for MN, to evaluate the evidence base for the clinical management of MN.
METHODS
Electronic biomedical databases (CINAHL, EMBASE, MEDLINE and Cochrane) were searched to January 2018 for studies evaluating the effectiveness of non-surgical interventions for Morton's neuroma. Outcome measures of interest were treatment success rate (SR) (binary) and pain as measured using 100-point visual analogue scale (VAS) (continuous). Studies with and without control groups were included and were evaluated for methodological quality using the Downs and Black Quality Index. Results from randomised controlled trials (RCT) were compared between-groups, and case series were compared pre- versus post-treatment. Effect estimates are presented as odds ratios (OR) for binary data or mean differences (MD) for continuous data. Random effects models were used to pool effect estimates across studies where similar treatments were used. Heterogeneity was assessed using the statistic.
RESULTS
A total of 25 studies met the inclusion criteria, seven RCTs and 18 pre/post case series. Eight different interventions were identified, with corticosteroid or sclerosing injections being the most often reported (seven studies each). Results from a meta-analysis of two RCTs found corticosteroid injection decreased pain more than control on VAS (WMD: -5.3, 95%CI: -7.5 to - 3.2). Other RCTs reported efficacy of: manipulation/mobilisation versus control (MD: -15.3, 95%CI: -29.6 to - 1.0); extracorporeal shockwave therapy versus control (MD: -5.9, 95%CI: -21.9 to 10.1). Treatment success was assessed for extracorporeal shockwave therapy versus control (OR: 0.3, 95%CI: 0.0 to 7.1); and corticosteroid injection vs footwear/padding (OR: 6.0, 95%CI: 1.9 to 19.2). Sclerosing and Botox injections, radiofrequency ablation and cryoneurolysis have been investigated by case series studies, however these were of limited methodological quality.
CONCLUSIONS
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.
Topics: Foot Orthoses; Glucocorticoids; Humans; Morton Neuroma; Musculoskeletal Manipulations; Pain Management; Randomized Controlled Trials as Topic; Sclerotherapy
PubMed: 30809275
DOI: 10.1186/s13047-019-0320-7 -
Journal of the American Podiatric... 2022Extracorporeal shockwave therapy (ESWT) was first introduced into clinical practice in 1982 and has been a beneficial inclusion to the noninvasive treatment option of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Extracorporeal shockwave therapy (ESWT) was first introduced into clinical practice in 1982 and has been a beneficial inclusion to the noninvasive treatment option of numerous orthopaedic pathologies. However, clinical evidence of the use of ESWT for various foot and ankle disorders has been limited with a consensus on its efficacy yet available. Therefore, the purpose of this study is to systematically review the literature, to provide a critical evaluation and meta-analysis for the use of ESWT in foot and ankle disorders.
METHODS
The PubMed and Embase databases were systematically reviewed and clinical studies that reported ESWT use for various foot and ankle disorders included.
RESULTS
A total of 24 clinical studies that included 12 randomized controlled trials and 12 case series were identified. Analysis of the evidence has indicated that ESWT can help manage plantar fasciitis, calcaneal spur, Achilles tendinopathy and Morton's neuroma. Meta-analysis of the change in pre- to post-VAS overall scores for plantar fasciitis significantly favored ESWT compared to placebo/conservative treatment with a MD -3.10 (95% CI, -4.36 to -1.83; I2 = 68%; P < 0.00001).
CONCLUSIONS
The current evidence has suggested that ESWT can provide symptomatic benefit to plantar fasciitis treatment, with minimal and unremarkable side effects. Overall, ESWT has been demonstrated to be a safe treatment option with a favorable complication profile. Further well-designed studies of ESWT for the treatment of calcaneal spurs, Achilles tendinopathy and Morton's neuroma are warranted to more soundly and safely support its current use. Future studies are suggested to investigate the optimization of ESWT treatment protocols.
Topics: Achilles Tendon; Ankle; Extracorporeal Shockwave Therapy; Fasciitis, Plantar; Heel Spur; Humans; Morton Neuroma; Tendinopathy; Treatment Outcome
PubMed: 34878537
DOI: 10.7547/18-191 -
Journal of Hand and Microsurgery Jul 2022
PubMed: 36016634
DOI: 10.1055/s-0040-1713081 -
Acta Bio-medica : Atenei Parmensis Mar 2022The aim of this study is to systematically review the literature on clinical outcomes of patients who have undergone infiltrative therapy for treatment of Morton's...
The aim of this study is to systematically review the literature on clinical outcomes of patients who have undergone infiltrative therapy for treatment of Morton's neuroma. As many kinds of substances are injected, the main outcome defines which treatment provides the best results in term of patient's satisfaction and pain relief, so that it would be possible to choose the best option. Many electronic databases were searched on July 2021; we have included prospective and retrospective case series, and randomized controlled trials of infiltrative treatments in patients with primary diagnosis of Morton's neuroma. The search returned 25 studies which met the inclusion criteria, with a total of 2243 cases. The incidence of outcomes was extracted and analyzed. Although many studies demonstrated favorable results in terms of pain relief and patient's satisfaction employing different substances for infiltration, alcohol injection appears results on long run.
Topics: Humans; Morton Neuroma; Pain Management; Patient Satisfaction; Prospective Studies; Randomized Controlled Trials as Topic; Retrospective Studies
PubMed: 35604266
DOI: 10.23750/abm.v92iS3.12545 -
Journal of Ultrasonography Jun 2021Morton's neuroma is a painful lesion of the interdigital nerve, usually at the third intermetatarsal space, associated with fibrotic changes in the nerve, microvascular...
Morton's neuroma is a painful lesion of the interdigital nerve, usually at the third intermetatarsal space, associated with fibrotic changes in the nerve, microvascular degeneration, and deregulation of sympathetic innervation. Patients usually present with burning or sharp metatarsalgia at the dorsal or plantar aspect of the foot. The management of Morton's neuroma starts with conservative measures, usually with limited efficacy, including orthotics and anti-inflammatory medication. When conservative treatment fails, a series of minimally invasive ultrasound-guided procedures can be employed as second-line treatments prior to surgery. Such procedures include infiltration of the area with a corticosteroid and local anesthetic, chemical neurolysis with alcohol or radiofrequency thermal neurolysis. Ultrasound aids in the accurate diagnosis of Morton's neuroma and guides the aforementioned treatment, so that significant and potentially long-lasting pain reduction can be achieved. In cases of initial treatment failure, the procedure can be repeated, usually leading to the complete remission of symptoms. Current data shows that minimally invasive treatments can significantly reduce the need for subsequent surgery in patients with persistent Morton's neuroma unresponsive to conservative measures. The purpose of this review is to present current data on the application of ultrasound for the diagnosis and treatment of Morton's neuroma, with emphasis on the outcomes of ultrasound-guided treatments.
PubMed: 34258038
DOI: 10.15557/JoU.2021.0022 -
AJR. American Journal of Roentgenology Apr 2018Central metatarsalgia relates to abnormalities of the second, third, and fourth metatarsals and their respective metatarsophalangeal joints. A variety of disorders... (Review)
Review
OBJECTIVE
Central metatarsalgia relates to abnormalities of the second, third, and fourth metatarsals and their respective metatarsophalangeal joints. A variety of disorders present with central forefoot pain; they range from traumatic lesions (acute or chronic repetitive), inflammatory and infective disorders, nonneoplastic soft-tissue lesions, and benign tumors to malignant lesions. Patients often present with symptoms of localized pain in the forefoot that worsens on weight bearing (walking or running), which can be sharp or dull and often is perceived as a lump felt inside or underneath the foot and described as walking on a marble or pebbles. These patients are labeled as having central metatarsalgia and are further evaluated with ultrasound or MRI to establish a diagnosis.
CONCLUSION
In this article, we review metatarsal and intermetatarsal lesions of the foot that present with central forefoot pain and a sensation of walking on pebbles, focusing on conditions mimicking Morton neuroma clinically or on imaging. We also briefly review some other plantar lesions and arthropathy that can present with awareness of lump underneath the foot.
Topics: Bursitis; Contrast Media; Cumulative Trauma Disorders; Diagnosis, Differential; Fractures, Stress; Ganglion Cysts; Granuloma, Foreign-Body; Humans; Joint Instability; Magnetic Resonance Imaging; Metatarsalgia; Morton Neuroma; Neoplasms; Osteonecrosis; Ultrasonography
PubMed: 29470159
DOI: 10.2214/AJR.17.18460