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Journal of Clinical Medicine May 2022Insufficient space below the Deep Transverse Metatarsal Ligament (DTML) could be an etiological factor for Morton’s Neuroma (MN). To date, there is a lack of studies...
Insufficient space below the Deep Transverse Metatarsal Ligament (DTML) could be an etiological factor for Morton’s Neuroma (MN). To date, there is a lack of studies measuring the space below the DTML. For this reason, this study assesses the intra- and inter-rater concordance and reproducibility of measurements of the space below the DTML between the third and the fourth metatarsal heads (M3 and M4) using ultrasound imaging to assess and verify the reliability and reproducibility of measurements of the space under the DTML. Forty feet from twenty patients were examined using ultrasound by three trained evaluators at two different times. The two measurements taken on each foot were: base (b)—distance between M3 and M4, and height (h)—distance between the DTML and the plantar skin surface. This was a quantitative, observational, analytical study. The concordance rate between observers for measurements of height and base were 98.5% and 99.5%, respectively. The mean area obtained of the space was 54.6 mm2 and 57.2 mm2 for both the left and right foot (p > 0.05). Reproducibility over time calculated in pre- and post-measurements showed an intraclass correlation coefficient of 1.00 (95%CI: 0.99−1.00), which leads us to conclude that the measurements are perfectly reproducible. Both measurements (height and base) of the space under the DTML, performed by ultrasound, are reliable and reproducible.
PubMed: 35566678
DOI: 10.3390/jcm11092553 -
Journal of Hand Surgery Global Online Jan 2023Painful neuromas commonly cause neuropathic pain, in up to 1 in 20 cases of traumatic or iatrogenic nerve injury. Despite the multiple surgical treatment types that...
PURPOSE
Painful neuromas commonly cause neuropathic pain, in up to 1 in 20 cases of traumatic or iatrogenic nerve injury. Despite the multiple surgical treatment types that reduce pain, no type has been universally accepted.
METHODS
We performed a retrospective cohort study by administering follow-up surveys to all surgical patients treated in our department for lower-extremity neuroma from September 1, 2015, to October 22, 2021, that could be contacted, excluding those with Morton neuroma. In addition to the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) questionnaire, survey questions covered the time to pain reduction, use of physical or occupational therapy, and characteristics of the pain. When available, previously collected preoperative and postoperative PROMIS PI data were used for patients who could not be contacted for the telephone survey. Paired-sample nonparametric testing was used to compare preoperative and postoperative PROMIS PI scores.
RESULTS
Initial query in the medical record by Current Procedural Terminology codes yielded 1,812 patients for chart review, of whom 33 were eligible to call. In total, 9 (27%) patients completed both preoperative and postoperative PROMIS PIs: 6 (18.2%) completed full telephone surveys and 3 (9.1%) had preoperative and postoperative PROMIS PI data in the chart review but could not be contacted for the full telephone survey. Four of the 6 telephone-survey respondents reported pain reduction within 12 months of their surgery. Wilcoxon signed-rank testing demonstrated a moderate but nonstatistically significant reduction in PROMIS PI scores, with a median difference of -4.85 ( = .1; 95% CI -12 to 1.2).
CONCLUSIONS
There were notable improvements in our cohort, but larger studies are needed to determine whether surgical treatment of lower-extremity neuroma results in a clinically important and significant difference in PROMIS PI scores, as well as to discern the advantages each treatment.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
PubMed: 36704377
DOI: 10.1016/j.jhsg.2022.03.005 -
Seminars in Musculoskeletal Radiology Dec 2022A variety of foot and ankle pathologies can impair patient's daily activities, ultimately requiring surgical management. However, with improvements in image-guided...
A variety of foot and ankle pathologies can impair patient's daily activities, ultimately requiring surgical management. However, with improvements in image-guided intervention, the joints, soft tissues, and osseous structures may be accessible using various percutaneous techniques as a potential alternative therapeutic tool, avoiding the need for surgery with its associated risks and morbidity. This article discusses the potential range of image-guided interventional treatments. Injections, aspiration, biopsies, cryoablation, and radiofrequency ablation are described. Newer novel treatments are also covered. Finally, the common pathologies of Morton's neuroma, Achilles tendinopathy, and plantar fasciitis are addressed.
Topics: Humans; Ankle; Achilles Tendon; Tendinopathy; Ankle Joint; Ultrasonography, Interventional
PubMed: 36791742
DOI: 10.1055/s-0042-1760120 -
Clinical Rehabilitation Dec 2019To assess the effectiveness of customized insole in patients with Morton's neuroma. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To assess the effectiveness of customized insole in patients with Morton's neuroma.
DESIGN
Double-blind randomized controlled trial with intent-to-treat analysis.
SETTING
Outpatients, University Hospital.
SUBJECTS
A total of 72 patients with Morton's neuroma met the inclusion criteria and were randomly allocated to either the study group ( = 36) or the control group ( = 36).
INTERVENTIONS
The study group was assigned to use a customized insole with metatarsal and arch support made of ethyl vinyl acetate and the control group received a flat insole of the same material, color, and density.
MAIN MEASURES
The primary outcome measure was walking pain intensity measured by the visual analogue scale. The secondary outcomes were as follows: pain at rest, palpation, and paresthesia (visual analogue scale); functional disability (6-minute walk test, Foot Function Index, and Foot Health Status Questionnaire); quality of life (Health Survey Short Form-36 (SF-36)); and foot pressure (AM Cube FootWalk Pro program).
RESULTS
In the comparison between the groups over time, a statistically significant difference, with improvement in favor of the experimental group, was found for pain during walking ( = 0.048); in the general health domains ( < 0.001) and physical activity ( = 0.025) of the Foot Health Status Questionnaire; in the general Foot Function Index score ( = 0.012); and in the functional capacity domain of the SF-36 questionnaire ( = 0.046). For the other parameters, no difference was found between groups.
CONCLUSION
The study demonstrated that customized insole with metatarsal and arch support relieved walking pain and improved patient-reported measures of function in patients with Morton's neuroma.
Topics: Adult; Double-Blind Method; Female; Foot Orthoses; Gait; Humans; Male; Middle Aged; Morton Neuroma; Patient Satisfaction; Quality of Life; Surveys and Questionnaires; Visual Analog Scale; Weight-Bearing
PubMed: 31505943
DOI: 10.1177/0269215519873949 -
Foot and Ankle Surgery : Official... Dec 2022Interdigital neuroma is one of the commonest causes of metatarsalgia. The reported success rate after excision of a primary neuroma is 74%. Recurrent symptoms after...
Interdigital neuroma is one of the commonest causes of metatarsalgia. The reported success rate after excision of a primary neuroma is 74%. Recurrent symptoms after neurectomy can be due to a recurrent interdigital neuroma. Recurrent interdigital neuromas can be diagnosed using sound clinical examination and ultrasonography. Surgical excision is the best treatment modality with varying success reported in the literature. We report on the clinical outcome following surgical excision of recurrent interdigital neuromas through a dorsal approach. All patients who had undergone excision of a recurrent interdigital neuroma by a single surgeon between 01/2010 and 12/2019 were identified. Inclusion criteria included patients having a preoperative ultrasound and postoperative histology report. The exclusion criteria were preexisting neuropathy or tarsal tunnel syndrome. Demographic data was collected, and a self-reported foot and ankle score questionnaire (SEFAS) was completed by the patient at their most recent follow-up. Twenty-three patients (25 feet) were included in the study. Mean time of follow-up was 75 (range 14-189) months. The mean age was 49 (range 15-71) years. Eleven (44%) recurrent neuromas were excised from the second webspace and 14 (56%) were excised from the third webspace. All excised masses were confirmed as recurrent neuromas histologically. Regarding the SEFAS score, 17 (73.93%) patients scored as excellent, one (4.34%) as good, three (13.04%) as fair, and two (8.69%) as poor. This long term follow-up study on outcomes after surgery for recurrent interdigital neuroma suggests that excision through a dorsal approach is an effective treatment option with a high patient satisfaction.
Topics: Humans; Adolescent; Young Adult; Adult; Middle Aged; Aged; Follow-Up Studies; Retrospective Studies; Morton Neuroma; Neuroma; Patient Reported Outcome Measures; Foot Diseases
PubMed: 35393246
DOI: 10.1016/j.fas.2022.03.013 -
Journal of Plastic, Reconstructive &... Oct 2021
Topics: Anatomy, Regional; Cadaver; Dissection; Forefoot, Human; Humans; Morton Neuroma; Nerve Transfer; Tibial Nerve
PubMed: 34175257
DOI: 10.1016/j.bjps.2021.05.053 -
Journal of the American Podiatric... Sep 2020Nonoperational treatments for Morton's neuroma remain controversial because it is believed that sclerosing injections do not change nerve fibers on a cellular level. Up...
BACKGROUND
Nonoperational treatments for Morton's neuroma remain controversial because it is believed that sclerosing injections do not change nerve fibers on a cellular level. Up to 80% success rates with 4% ethanol sclerosing have been documented, and the remainder required operational removal of the painful nerve. We sought to evaluate the histologic characteristics of Morton's neuromas treated with 4% ethanol sclerosing injection versus corticosteroid injection alone in patients who required removal of the nerve for pain relief.
METHODS
A retrospective histologic review was performed of 23 consecutive patients who were treated with either sclerosing injection or nonsclerosing injection and underwent nerve removal between September 1, 2012, and February 28, 2015.
RESULTS
Of 19 patients who met the inclusion criteria, eight received sclerosing injections and 11 received nonsclerosing injections. Intraneural fibrosis was more severe in the nonsclerosing injection group (P = .008).
CONCLUSION
Histologic changes are seen in Morton's neuroma with the use of 4% ethanol sclerosing injection, contrary to findings from previous studies.
Topics: Ethanol; Humans; Morton Neuroma; Neuroma; Retrospective Studies; Sclerosing Solutions; Sclerotherapy
PubMed: 32667994
DOI: 10.7547/17-094 -
Radiology Case Reports Jul 2023A 51-year-old lady with a background of rheumatoid arthritis presented to the foot and ankle clinic with pain and a typical history of Morton's neuroma. Examination...
A 51-year-old lady with a background of rheumatoid arthritis presented to the foot and ankle clinic with pain and a typical history of Morton's neuroma. Examination revealed a palpable swelling over the right foot in the third intermetatarsal space. Following failed conservative management, the patient underwent excision of the neuroma. Histology revealed of necrotizing granulomas with peripheral palisading and no evidence of features specific to a neuroma. This has rarely been described previously and supports the concept of rheumatoid synovitis and nodules producing symptoms mimicking Morton's neuroma/metatarsalgia. 4.
PubMed: 37214324
DOI: 10.1016/j.radcr.2023.04.001 -
The Journal of Foot and Ankle Surgery :... 2020This clinical study compares the use of dorsal nerve relocation (DNR; also known as dorsal nerve transfer) and dorsal neurectomy (DN) in the surgical management of...
This clinical study compares the use of dorsal nerve relocation (DNR; also known as dorsal nerve transfer) and dorsal neurectomy (DN) in the surgical management of Morton's neuroma within the surgical directorate of an NHS Hospital Trust (Princess Royal University Hospital) in the South East of England between 2002 and 2009. Approaches to the surgical management of Morton's neuroma are dependent on the views of individual surgeons, rather than empirical evidence and varied considerably, so this study was essentially all about checking whether best practice is being followed and making improvements. Data were collected using an in-depth review of patients' case notes and patient questionnaires. In total, there were 47 cases (51 web spaces), 25 (28 web spaces) in the DNR group, and 22 (23 web spaces) in the DN group. The key indication for surgery in all cases reviewed was failure of the condition to improve using conservative methods. The mean follow-up duration was 36 months (12-89) in the DNR group and 41 months (12 69) in the DN group. Coughlin's criterion was used to analyze individual records. The results suggest that DNR is more effective (92%) than DN in the surgical management of Morton's neuroma (82%). Key advantages of DNR include earlier return to wearing routine footwear, earlier return to normal routine/work, and better resolution of sensory symptoms in the toes. Although DNR is a slightly longer procedure than DN, minor difficulties were encountered relating to nerve mobilization because of overlying prominent veins or multiple nerve branches rather than a single nerve. DNR avoids the risk of a stump neuroma formation. Our results, although supporting the literature, are not statistically significant. There are no direct comparative studies between DNR and DN in the literature, and therefore potential for more studies in the form of prospective randomized trials to establish a robust evidential basis for the surgical management of Morton's neuroma are needed.
Topics: Denervation; Foot Diseases; Humans; Morton Neuroma; Neuroma; Prospective Studies; Toes
PubMed: 32893106
DOI: 10.1053/j.jfas.2020.04.001 -
Foot and Ankle Surgery : Official... Jun 2021The aim of this paper is to analyze the effectiveness of corticosteroid injections (CI), in combination with or without a local anaesthetic, for Civinini-Morton's...
BACKGROUND
The aim of this paper is to analyze the effectiveness of corticosteroid injections (CI), in combination with or without a local anaesthetic, for Civinini-Morton's Syndrome to determine which protocol could be the most appropriate among conservative treatments.
METHODS
All selected articles were screened using a thorough database search of PubMed, EMBASE and SCOPUS to assess their suitability to the research focus.
RESULTS
Selection produced 10 articles as full-text, for a total of 590 patients, with a mean follow-up of 14 ± 14.2 (range 3-48) months. Johnson satisfaction scale, resulting from 6 studies, scored 25.6% (range 5-38) and 39.4% (range 15-51.8), respectively completely satisfied and satisfied with minor reservations. Mean VAS, declared in 5 studies, decreased from 70.7 ± 16.5 (range 67-89) to 33.4 ± 7.6 (26-42.5) points (p < 0.01). Most common complication was skin depigmentation in 7 (2.6%) cases.
CONCLUSIONS
CI appear to be a safe treatment allowing good results with a very low complications rate. A neuroma of 6.3 mm seems to be the cut-off size; below which CI could have best indications and be considered as an intermediate treatment between shoe modifications and more invasive procedures such as percutaneous alcoholization or surgery.
LEVEL OF EVIDENCE
Level II, systematic review.
Topics: Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Conservative Treatment; Female; Follow-Up Studies; Humans; Injections; Male; Middle Aged; Morton Neuroma; Retrospective Studies; Syndrome; Treatment Outcome; Young Adult
PubMed: 32600970
DOI: 10.1016/j.fas.2020.05.001