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Journal of the American Podiatric... Sep 2020Morton's neuromas are abnormalities of the common digital nerve branch located between the lesser metatarsal heads. Historically, interdigital (Morton's) neuromas have...
BACKGROUND
Morton's neuromas are abnormalities of the common digital nerve branch located between the lesser metatarsal heads. Historically, interdigital (Morton's) neuromas have been characterized as being most common in the third interspace and in females. The principal investigator observed Morton's neuromas commonly in the second and third interspaces in both sexes. To our knowledge, no literature exists to evaluate Morton's neuroma location with a focus on each sex independently. The present study evaluates Morton's neuroma interspace location and whether there is a variation by sex.
METHODS
In this retrospective study, 582 deidentified magnetic resonance imaging reports with a diagnosis code for Morton's neuroma were evaluated for patients scanned from January 2, 2015, through April 19, 2016. Incomplete records and those with radiologist findings inconsistent with Morton's neuroma were eliminated. For the remaining 379 patients, data were collected on sex, laterality, history of trauma, plantar plate tear, age, and interspace location. Special focus was given to second and third interspace Morton's neuromas. Data were evaluated using the Pearson χ2 and independent-samples Mann-Whitney U tests, with P < .05 indicating statistical significance.
RESULTS
No statistically significant distribution between sex and second and third interspace Morton's neuromas was noted. Right vs left foot, age, and history of trauma did not vary statistically significantly between sexes. There was a statistically significant difference between the presence of plantar plate tears between sexes. Male patients with Morton's neuromas were found to have a higher rate of plantar plate tears (P = .01).
CONCLUSIONS
This study found that there were no statistically significant differences between sexes and Morton's neuromas location, laterality, or age.
Topics: Female; Foot; Foot Diseases; Humans; Male; Morton Neuroma; Neuroma; Prevalence; Retrospective Studies
PubMed: 33179062
DOI: 10.7547/18-809 -
AJR. American Journal of Roentgenology Feb 2022. Morton neuroma is a common, painful disorder of the foot with multiple treatment options of varying cost and effectiveness. . The aim of this study was to determine... (Comparative Study)
Comparative Study
. Morton neuroma is a common, painful disorder of the foot with multiple treatment options of varying cost and effectiveness. . The aim of this study was to determine the most cost-effective treatment pathway for symptomatic Morton neuromas when conservative management has failed. . An incremental cost-utility analysis was performed comparing a direct to surgical neurectomy strategy with three selective injection strategies in which one or more ultrasound-guided injection therapies was tried first before surgery for patients who did not respond to treatment. The three selective injection strategies were selective steroid injection, selective alcohol injection, and selective steroid/alcohol injection in which both steroid injections and alcohol sclerosing injections were trialed successively before surgical neurectomy. The direct-to-surgery approach was compared with the three different selective injection strategies and with a no-treatment strategy in a decision-analytic model for a hypothetical group of patients with symptomatic Morton neuroma in whom conservative management had failed. Model parameters, including treatment costs, effectiveness, complication rates, and health utility states, were estimated from the literature, reimbursement databases, and expert opinion. The outcome was cost per quality-adjusted life year (QALY) with a time horizon of 3 years. A societal cost perspective was adopted with a willingness-to-pay threshold of $100,000/QALY. Sensitivity analyses for key model parameters were performed. . For the base input values, the steroid/alcohol selective injection strategy was dominant and yielded an incremental cost-effectiveness ratio of $4401.61/QALY compared with no treatment. The probabilistic sensitivity analysis supported this strategy in 74% of 10,000 simulated trials. Results were robust with low sensitivity to most input parameters. However, when the probability of successful alcohol injection treatment dropped below 40%, the steroid selective injection strategy became most cost-effective. . A trial of ultrasound-guided injection therapies for Morton neuroma is a cost-effective strategy compared with proceeding directly to surgical neurectomy. . Ultrasound-guided injection therapies are indicated as first-line treatment of patients with symptomatic Morton neuromas when conservative management fails.
Topics: Adrenal Cortex Hormones; Cost-Benefit Analysis; Denervation; Ethanol; Health Care Costs; Humans; Morton Neuroma; Treatment Outcome; Ultrasonography, Interventional
PubMed: 34523955
DOI: 10.2214/AJR.21.26419 -
Journal of Ultrasonography Oct 2023Radiography is the appropriate initial imaging modality to assess for midfoot and forefoot pathology before turning to advanced imaging techniques. While most lesions of...
Radiography is the appropriate initial imaging modality to assess for midfoot and forefoot pathology before turning to advanced imaging techniques. While most lesions of the mid- and forefoot can be diagnosed clinically, the exact nature and severity of the pathology is often unclear. This review addresses the use of the ultrasound, as well as the added value of magnetic resonance imaging, in diagnosing conditions of the midfoot and forefoot. Ultrasound allows a dynamic assessment as well as enabling imaging-guided interventions for diagnostic and therapeutic purposes. Practical tips for optimal examination of this area with ultrasound and magnetic resonance imaging are provided. Metatarsal stress fracture, Chopart's injury, Lisfranc injury, as well as the 1 metatarsophalangeal joint injury and lesser metatarsophalangeal plantar plate injury are injuries unique to the mid- and forefoot. The imaging anatomy of the 1 and lesser metatarsophalangeal joints is reviewed, as such knowledge is key to correctly assessing injury of these joints. Characteristic imaging features of masses commonly encountered in the mid- and forefoot, such as ganglion cyst, Morton neuroma, gouty tophus, plantar fibroma, foreign body granuloma, and leiomyoma are reviewed. The use of ultrasound and magnetic resonance imaging in assessing degenerative and inflammatory joint disorders, and in particular rheumatoid arthritis, of the mid- and forefoot region is also reviewed. In summary, when necessary, most lesions of the mid-and forefoot can be adequately assessed with ultrasound, supplemented on occasion with radiographs, computed tomography, or magnetic resonance imaging.
PubMed: 38020514
DOI: 10.15557/jou.2023.0033 -
Journal of Ultrasound in Medicine :... Sep 2019Sonography is often used for analysis of Morton neuromas, but the measurement reliability is unknown. The aim of this study was to determine the intra- and interobserver...
OBJECTIVES
Sonography is often used for analysis of Morton neuromas, but the measurement reliability is unknown. The aim of this study was to determine the intra- and interobserver reliability and precision of sonographic measurement of Morton neuromas.
METHODS
Three observers with different levels of sonography experience (observer A, expert; observer B, intermediate; observer C, beginner) performed repeated measurements of the size of Morton's neuroma in 20 patients. Intraclass correlation coefficient and limit of agreement were used to evaluate reliability and measurement precision.
RESULTS
The intraclass correlation coefficient for intraobserver reliability was 0.80, 0.71, and 0.43 (limit of agreement, 20%, 18%, and 47%) in observers A, B, and C, respectively. The intraclass correlation coefficient for interobserver reliability was 0.72, 0.38, and 0.38 (limit of agreement, 25%, 36%, and 35%) between observers A/B, A/C, and B/C, respectively.
CONCLUSIONS
The intra- and interobserver reliability values for sonographic measurement of Morton neuroma size were dependent on observer experience. Experienced observers had higher reliability, while observers who were less familiar with sonography showed moderate to low reliability.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Morton Neuroma; Observer Variation; Reproducibility of Results; Severity of Illness Index; Ultrasonography
PubMed: 30618089
DOI: 10.1002/jum.14928 -
Cureus Jan 2022A 63-year-old female patient, with a past history of rheumatoid arthritis, presented with insidious pain on the left foot second and third metatarsophalangeal joints,...
A 63-year-old female patient, with a past history of rheumatoid arthritis, presented with insidious pain on the left foot second and third metatarsophalangeal joints, associated with swelling and morning stiffness (mean time: four hours). Physical examination evidenced a tender and soft nodularity in the third intermetatarsal space, along with sharp pain, consistent with Morton's neuroma. Foot ultrasound suggested Morton's neuroma, but not excluding the possibility of rheumatoid arthritis involvement. Foot magnetic resonance imaging suggested the possibility of extensive synovitis of the third metatarsophalangeal joint, but not excluding the coexistence of Morton's neuroma because of the mass effect. Finally, the patient underwent an ultrasound-guided needle biopsy of the nodule, which confirmed metatarsophalangeal joint synovitis. The foot is a common location of rheumatoid arthritis manifestation, and metatarsophalangeal joint synovitis can mimic Morton's neuroma. After a definite diagnosis, the patient recovered lower limb functional impairment after introducing adalimumab and a rehabilitation program. This case highlights the importance of an accurate differential diagnosis, pharmacological rheumatoid arthritis control, and physical medicine and rehabilitation programs to optimal clinical and functional improvement.
PubMed: 35251822
DOI: 10.7759/cureus.21751 -
Foot & Ankle Specialist Aug 2022Although the precise pathoetiology of Morton's neuroma remains unclear, chronic nerve entrapment from the overlying intermetatarsal ligament (IML) may play a role....
BACKGROUND
Although the precise pathoetiology of Morton's neuroma remains unclear, chronic nerve entrapment from the overlying intermetatarsal ligament (IML) may play a role. Traditional operative management entails neuroma excision but risks unpredictable formation of stump neuroma.
MATERIALS AND METHODS
Medical records were examined for adult patients who failed at least 3 months of conservative treatment for symptomatic and recalcitrant Morton's neuroma and who then underwent isolated IML decompression without neuroma resection.
RESULTS
A total of 12 patients underwent isolated IML decompression for Morton's neuroma with an average follow-up of 13.5 months. Visual Analog Pain Scale averaged 6.4 ± 1.8 (4-9) preoperatively and decreased to an average of 2 ± 2.1 (0-7) at final follow-up (P = .002). All patients reported significant improvement.
CONCLUSION
Isolated IML release of chronically symptomatic Morton's neuroma shows promising short-term results regarding pain relief, with no demonstrated risk of recurrent neuroma formation, permanent numbness, or postoperative symptom exacerbation.
LEVEL OF EVIDENCE
.
Topics: Adult; Foot; Humans; Ligaments, Articular; Morton Neuroma; Neuroma; Retrospective Studies
PubMed: 32954808
DOI: 10.1177/1938640020957851 -
Clinics in Podiatric Medicine and... Jan 2024Understanding the evolution of the human foot from a flexible grasping structure to one that is designed for upright posture and locomotion is paramount to treating... (Review)
Review
Understanding the evolution of the human foot from a flexible grasping structure to one that is designed for upright posture and locomotion is paramount to treating patients with foot pain and dysfunction. Almost 100 years ago, Dudley Morton observed that certain retained atavistic traits are responsible for pathologic breakdown of the modern foot. Cadaveric research under the direction of Jeffrey Christensen provided evidence that lengthening the gastrocnemius and stabilizing the medial column helped correct the faulty biomechanics associated with Morton foot and corroborated Hansen's blueprint for reconstructive surgery of the foot and ankle.
Topics: Humans; Foot; Morton Neuroma
PubMed: 37951677
DOI: 10.1016/j.cpm.2023.06.010 -
La Radiologia Medica Jul 2021No prior studies investigated the role of ultrasound in the assessment of response of patients undergoing treatment of metatarsalgia with custom-made orthoses. Our aim...
PURPOSE
No prior studies investigated the role of ultrasound in the assessment of response of patients undergoing treatment of metatarsalgia with custom-made orthoses. Our aim was to describe ultrasound findings of patients with plantar forefoot pain treated with custom-made foot orthoses.
METHODS
Twenty patients (15 females; mean age: 62.6 ± 11 years) affected by metatarsalgia in 27/40 feet underwent clinical evaluation before, three months and six months after treatment with custom-made full foot insole with a support proximal and an excavation below the painful metatarsals. Ultrasound was performed before and three months after the use of orthoses to examine the presence of intermetatarsal/submetatarsal bursitis, metatarsophalangeal joints effusion, anterior plantar fat pad oedema, flexor tendinitis/tenosynovitis, and Morton's neuroma. Outcome measures were clinical response with Foot Function Index (FFI)/Visual Analogue Scale (VAS) and ultrasound features changes.
RESULTS
Median VAS and FFI before treatment were 8[5-8.5] and 45.85[32.4-59.4], respectively. After 3 and 6 months of insoles use, both median VAS (2.5 [0-5] and 0 [0-2.75], respectively) and median FFI (7.9 [3.95-20] and 0 [0-3.95], respectively) showed a significant reduction in pain and disability (p < .001). Before treatment, ultrasound revealed 22 intermetatarsal bursitis, 16 submetatarsal bursitis, 10 joint effusions, 20 fat pad oedema, 3 flexor tendinitis/tenosynovitis and 3 Morton's neuromas. After 3 months of treatment, a significant decrease of intermetatarsal bursitis (7, p < .001) was observed. No significant changes were observed in any other ultrasound parameters.
CONCLUSION
Ultrasound might be able to detect some imaging features associated with the response of forefoot pain to custom-made foot orthoses, especially intermetatarsal bursitis.
Topics: Adult; Aged; Equipment Design; Female; Follow-Up Studies; Foot Orthoses; Forefoot, Human; Humans; Male; Metatarsalgia; Middle Aged; Retrospective Studies; Ultrasonography
PubMed: 33881714
DOI: 10.1007/s11547-021-01354-8 -
Zeitschrift Fur Rheumatologie Apr 2022The goal was to assess public interest in a wide range of musculoskeletal symptoms and disorders during the coronavirus disease 2019 (COVID-19) pandemic.
OBJECTIVE
The goal was to assess public interest in a wide range of musculoskeletal symptoms and disorders during the coronavirus disease 2019 (COVID-19) pandemic.
METHODS
We searched Google Trends for 118 search queries within the United States. We compared two timeframes of 2020 (March 15-July 4 and July 5-October 31) to similar timeframes over the four prior years (2016-2019).
RESULTS
In the early pandemic, March 15-July 4, a statistically significant decrease in relative search volume of the majority of queries (60%) was detected, with a significant increase in only 2 queries (i.e. myalgia and toe swelling). In the phase July through October, a statistically significant decrease was detected in only 22% of search queries; there was no difference for 60% of search queries between 2020 and 2016-2019 suggesting a return to their prior levels for most of search queries. Interestingly, the search volume of 18% of search queries (i.e. fatigue, joint pain, muscle pain, myalgia, spondylosis, radiculopathy, myelopathy, neck pain, neck strain, lower back strain, sciatica, shoulder pain, frozen shoulder, elbow pain, lateral epicondylitis, wrist pain, carpal tunnel, hand pain, finger pain, trigger finger, and Morton's neuroma) was significantly increased compared with the four prior years.
CONCLUSION
Public interest focused on COVID-19 and sought online information for COVID-19 symptoms in the early pandemic. In the period July through October, there was an upward trend in musculoskeletal symptoms and some colloquial terms/well-known musculoskeletal conditions coupled with a downward trend in general musculoskeletal disorder terms and certain specific diagnoses. This information may help rheumatologists understand public interest in musculoskeletal symptoms and disorders and address the needs of patients to mitigate the negative impact of the pandemic on outcomes.
Topics: COVID-19; Humans; Infodemiology; Musculoskeletal Diseases; Pandemics; Search Engine; United States
PubMed: 33779835
DOI: 10.1007/s00393-021-00989-2 -
Foot & Ankle International May 2020Morton's neuroma is a common cause of forefoot pain. Various conservative methods (injections of various pharmacologic agents) have been published with an outcome of...
BACKGROUND
Morton's neuroma is a common cause of forefoot pain. Various conservative methods (injections of various pharmacologic agents) have been published with an outcome of 6%-75% success rate (free of pain in daily life) per injection. The aim of the present study was to assess the outcome of an improved localization technique, a higher dosage, and a higher percentage of ethanol.
METHODS
Using fluoroscopic and electroneurographic guidance, 2.5 mL of 70% ethanol were injected into 33 feet with a magnetic resonance imaging (MRI)-verified neuroma. We evaluated patients at up to 5-year follow-up.
RESULTS
A "success rate" of more than 82% per single injection (defined as free of pain in daily life) was achieved and no recurrence was seen over 5 years. All scores (visual analog scale; Short Form-36 subscales, American Orthopaedic Foot & Ankle Society ankle-hindfoot score) showed significant improvement ( < .0001). Mean 1.2 injections were necessary. No significant side effects were seen. However, some mild pain persisted in some patients who participated in sports.
CONCLUSION
The injection of 2.5 mL of 70% ethanol under fluoroscopic and electroneurographic guidance was a safe method for the treatment of MRI-verified Morton's neuromas. Combining the effect of a higher percentage of alcohol and a higher dosage and an improved localization technique resulted in a high rate of patients without pain.
LEVEL OF EVIDENCE
Level IV, cases series, prospective.
Topics: Adult; Aged; Ethanol; Female; Fluoroscopy; Humans; Injections, Intralesional; Male; Middle Aged; Morton Neuroma; Prospective Studies
PubMed: 32013586
DOI: 10.1177/1071100720903096