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European Radiology Dec 2022This work compares the effectiveness of blind versus ultrasound (US)-guided injections for Morton neuroma (MN) up to 3 years of follow-up. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
This work compares the effectiveness of blind versus ultrasound (US)-guided injections for Morton neuroma (MN) up to 3 years of follow-up.
METHODS
This is an evaluator-blinded randomised trial in which 33 patients with MN were injected by an experienced orthopaedic surgeon based on anatomical landmarks (blind injection, group 1) and 38 patients were injected by an experienced musculoskeletal radiologist under US guidance (group 2). Patients were assessed using the visual analogue scale and the Manchester Foot Pain and Disability index (MFPDI). Injections consisted of 1 ml of 2% mepivacaine and 40 mg triamcinolone acetonide in each web space with MN. Up to 4 injections were allowed during the first 3 months of follow-up. Follow-up was performed by phone calls and/or scheduled consultations at 15 days, 1 month, 45 days, 2 months, 3 months, 6 months and 1, 2 and 3 years. Statistical analysis was performed using unpaired Student's t tests.
RESULTS
No differences in age or clinical measures were found at presentation between group 1 (VAS, 8.5 ± 0.2; MFPDI, 40.9 ± 1.1) and group 2 (VAS, 8.4 ± 0.2; MFPDI, 39.8 ± 1.2). Improvement in VAS was superior in group 2 up to 3 years of follow-up (p < 0.05). Improvement in MFPDI was superior in group 2 from 45 days to 2 years of follow-up (p < 0.05). Satisfaction with the treatment was higher in group 2 (87%) versus group 1 (59.1%) at 3 years of follow-up.
CONCLUSION
Ultrasound-guided injections lead to a greater percentage of long-term improvement than blind injections in MN.
KEY POINTS
• Ultrasound-guided corticosteroid injections in Morton neuroma provide long-term pain relief in more than 75% of patients. • Ultrasound-guided injections in Morton neuroma led to greater long-term pain relief and less disability than blind injections up to 3 years of follow-up. • The presence of an ipsilateral neuroma is associated with worse long-term disability score.
Topics: Humans; Morton Neuroma; Mepivacaine; Adrenal Cortex Hormones; Neuroma; Pain; Ultrasonography, Interventional; Treatment Outcome
PubMed: 35726101
DOI: 10.1007/s00330-022-08932-y -
Foot & Ankle Specialist Dec 2017Interdigital neuroma (IN), otherwise known as Morton's neuroma, is a common cause of metatarsalgia presenting to the elective foot and ankle clinic. Surgical excision of...
BACKGROUND
Interdigital neuroma (IN), otherwise known as Morton's neuroma, is a common cause of metatarsalgia presenting to the elective foot and ankle clinic. Surgical excision of the IN in patients who fail to respond to nonoperative measures is considered to be the gold standard of care in many centers. The Royal College of Pathologists UK recommend that all excised interdigital Morton's neuromas are sent for formal histopathological analysis. We present a study correlating clinical and radiological diagnosis with histopathologic appearances of IN following surgical excision, and question if routine histopathological analysis is warranted.
METHODS
A retrospective study was carried out in a single center. Ninety-six operative records were reviewed to identify all the cases of IN surgically resected between January 2007 and July 2016. The histopathology result of the resected IN specimen, that had a clinical and radiological diagnosis of IN, was analyzed.
RESULTS
A total of 85 patients met the inclusion criteria and were included in the final analysis. We found that 100% of patients with a clinical, radiographic, and intraoperative diagnosis of a Morton's neuroma had a histopathological report confirming a Morton's interdigital neuroma.
CONCLUSION
In our single-surgeon series, histopathologic diagnosis is in complete agreement with clinical and radiological diagnosis. We therefore recommend that routine histopathological analysis of IN is not necessary, saving resources and providing a cost benefit. Histopathologic examination should be reserved only in cases where intraoperative findings do not concur with clinical and radiological features.
LEVELS OF EVIDENCE
Level IV: Case series.
Topics: Adult; Aged; Biopsy, Needle; Cohort Studies; Female; Follow-Up Studies; Foot Diseases; Humans; Immunohistochemistry; Male; Metatarsalgia; Middle Aged; Morton Neuroma; Pain Measurement; Radiography; Retrospective Studies; Treatment Outcome; United Kingdom
PubMed: 28030965
DOI: 10.1177/1938640016685151 -
Physiotherapy Canada. Physiotherapie... 2019Morton's neuroma (MN) is a neuralgia involving the common plantar digital nerves of the metatarsal region. Evidence-based treatment options for this condition are...
Morton's neuroma (MN) is a neuralgia involving the common plantar digital nerves of the metatarsal region. Evidence-based treatment options for this condition are sparse, and physiotherapy's usefulness is limited. A woman aged 44 years was referred to physiotherapy for left forefoot pain lasting 3 months. The podiatrist diagnosed MN using ultrasonography. Examination found positive squeeze test, painful interphalangeals and metatarsal heads, and painful metatarsophalangeal joint (MPJ) extension. Repeated flexion of MPJ digit II relieved the patient's pain. She was treated six times over 3 months to progress treatment, achieve longer lasting pain relief, and recover function to full pain-free status, including running. The patient's pain reduced after treatment from a variable 2-7 out of 10 on the Numeric Pain Rating Scale to 0 out of 10. After two sessions, the patient's Lower Extremity Functional Scale score improved, from 56 out of 80 to 70 out of 80, and by discharge, it was 73 out of 80. At 6-month follow-up, the patient was still running pain-free. This article describes the rapid and lasting improvement in chronic forefoot pain associated with MN after mechanical diagnosis and therapy assessment and treatment. Finding new, effective, conservative interventions is important for this condition because so few evidence-supported treatments exist. The findings from this case report demonstrate the benefit derived from exercise-based treatment and may indicate a role for physiotherapy in managing MN.
PubMed: 31040508
DOI: 10.3138/ptc.2018-42 -
Muscle & Nerve Feb 2014We describe a simple and quickly applied electrodiagnostic method for confirming the diagnosis of interdigital neuropathy caused by Morton neuroma (MN).
INTRODUCTION
We describe a simple and quickly applied electrodiagnostic method for confirming the diagnosis of interdigital neuropathy caused by Morton neuroma (MN).
METHODS
Interdigital nerves II-III and III-IV were stimulated with surface electrodes simultaneously touching the lateral side of 1 toe and the medial side of the other. Recording was also made with surface electrodes. The results of 20 normal controls and 14 patients with MN were evaluated.
RESULTS
The amplitude and peak latency values elicited in the patients as well as the interside differences revealed an acceptable abnormality rate between 57.1% and 71.4%.
CONCLUSIONS
Although the most popular and effective method of MN diagnosis is clinical evaluation supported by imaging, electrophysiological studies can, in selected patients, provide valuable information.
Topics: Adult; Aged; Electric Stimulation; Electrodiagnosis; Electrophysiological Phenomena; Female; Foot; Humans; Male; Middle Aged; Neuroma; Sensitivity and Specificity
PubMed: 23649839
DOI: 10.1002/mus.23899 -
Clinical Radiology Oct 2019To assess the efficacy and safety of ultrasound-guided radiofrequency ablation (RFA) for treatment of symptomatic Morton's neuroma.
AIM
To assess the efficacy and safety of ultrasound-guided radiofrequency ablation (RFA) for treatment of symptomatic Morton's neuroma.
MATERIALS AND METHODS
Patients with symptomatic Morton's neuroma of the foot were referred for treatment with RFA, prior to consideration for surgery. All neuromas were proven by ultrasound imaging and had a trial of conservative management including orthotic support and/or steroid injections. Ultrasound-guided RFA was performed as an outpatient procedure under local anaesthetic. Patients were followed up at 8 weeks and 8 months. Outcomes were assessed with a visual analogue scale (VAS) score, Manchester-Oxford Foot and Ankle Questionnaire, overall patient satisfaction, and complications.
RESULTS
Twenty-two neuromas were treated with RFA under ultrasound guidance. The VAS score at 8 weeks was significantly lower than the VAS score pre-procedure (p<0.001, Wilcoxon signed ranks test) and the VAS score at 8 months was significantly lower than the VAS score at 8 weeks (p=0.008, Wilcoxon signed ranks test). At 8 months, 89% of treated patients were satisfied with the procedure outcome. No significant adverse effects were recorded.
CONCLUSION
Ultrasound-guided RFA is safe, with excellent initial results in treatment of symptomatic Morton's neuroma. Further studies on long-term outcomes and comparison to other management options will be required to establish its role in management of symptomatic Morton's neuroma.
Topics: Adult; Aged; Anesthetics, Local; Female; Humans; Lidocaine; Male; Middle Aged; Morton Neuroma; Patient Satisfaction; Radiofrequency Ablation; Ultrasonography, Interventional; Visual Analog Scale; Young Adult
PubMed: 31409448
DOI: 10.1016/j.crad.2019.07.002 -
Korean Journal of Radiology 2007The purpose of this study was to compare the diagnostic accuracy of both ultrasonography (US) and magnetic resonance imaging (MRI) for the assessment of Morton neuroma. (Comparative Study)
Comparative Study
OBJECTIVE
The purpose of this study was to compare the diagnostic accuracy of both ultrasonography (US) and magnetic resonance imaging (MRI) for the assessment of Morton neuroma.
MATERIALS AND METHODS
Our study group was comprised of 20 neuromas from 17 patients, and the neuromas were confirmed on surgery following evaluation with US, MRI, or both US and MRI. The diagnostic criterion for Morton neuroma, as examined by US, was the presence of a round or ovoid, well-defined, hypoechoic mass. The diagnostic criterion, based on MR imaging, was a well defined mass with intermediate to low signal intensity on both the T1- and T2-weighted images. The retrospective comparison between the sonographic and MR images was done by two experienced radiologists working in consensus with the surgical and pathologic correlations.
RESULTS
The detection rate of Morton neuroma was 79% for 14 neuromas from 11 patients who had undergone US followed by an operation. The detection rate was 76% for 17 neuromas from 15 patients who had undergone MRI and a subsequent operation. The mean size of the examined neuromas was 4.9 mm on the US images and it was 5.1 mm on the MRI studies. Ten neuromas (71%) were 5 mm or less as measured by US, and three neuromas were not detected, whereas on the MRI analysis, 10 neuromas (59%) were 5 mm or less and four neuromas were not visualized. Among the patients examined during postoperative follow-up, symptoms were completely relieved in 85% and the symptoms were partially relieved in 15%.
CONCLUSION
US and MR imaging are comparable modalities with high detection rate for the evaluation of Morton neuroma.
Topics: Adult; Aged; Contrast Media; Diagnosis, Differential; Female; Foot Diseases; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuroma; Treatment Outcome; Ultrasonography
PubMed: 17420632
DOI: 10.3348/kjr.2007.8.2.148 -
International Orthopaedics Sep 2013Long-term results following surgical treatment of Morton neuroma are rare. The purpose of the present study was to evaluate patients after excision of Morton's neuroma...
PURPOSE
Long-term results following surgical treatment of Morton neuroma are rare. The purpose of the present study was to evaluate patients after excision of Morton's neuroma at least ten years following surgery.
METHODS
We performed a retrospective review of the patients' records who underwent excision of an interdigital neuroma with the clinical diagnosis of Morton's neuroma. Eighty-one patients who had undergone surgery on 98 feet were analysed at an average of 15.3 years postoperatively. In total 111 neuromas were excised, because in 13 feet more than one neuroma was identified clinically. Follow-up evaluation included physical examination and a radiographic evaluation. The interdigital neuroma clinical evaluation score and the AOFAS score were assessed.
RESULTS
An excellent result was reported for 44 feet (44.9 %), a good result for 31 feet (31.6 %) and a fair one for 15 feet (15,3 %). Eight feet had a poor result (8.2 %), in all of them an amputation neuroma was diagnosed. The average neuroma score was 62 points (range 20-80) and the AOFAS score 75 points (range 29-100). Sixty-one feet (62.2 %) had concomitant foot and ankle disorders not related to the primary diagnosis of Morton's neuroma. Numbness was assessed in 72 % (72 feet), a normal sensibility in 26 % (26 feet) and dyaesthesia in 1 % (one foot). The clinical outcome was not influenced by existence of sensory deficits (p = 0.646); analysis of location of neuroma showed best results for those in the third webspace. A significantly worse outcome was found in patients operated on multiple neuromas compared to single neuroma (p = 0.038).
CONCLUSION
Surgical excision of a Morton's neuroma results in good clinical results and high overall patient's satisfaction in the long term. Multiple neuromas have worse outcome than single neuromas. Sensory deficits and concomitant foot and ankles disorders are common, but do not have an influence on patient's satisfaction.
Topics: Adult; Aged; Female; Follow-Up Studies; Foot Diseases; Humans; Male; Middle Aged; Neuroma; Patient Satisfaction; Retrospective Studies; Toes; Treatment Outcome; Young Adult
PubMed: 23851648
DOI: 10.1007/s00264-013-2002-6 -
Foot & Ankle International Dec 2020Morton's neuroma (MN) is often a diagnostic dilemma lacking a gold standard set of diagnostic criteria. Advanced imaging of MN is evolving including ultrasonography. The...
BACKGROUND
Morton's neuroma (MN) is often a diagnostic dilemma lacking a gold standard set of diagnostic criteria. Advanced imaging of MN is evolving including ultrasonography. The current study aimed to analyze the relationship between ultrasonographic findings and symptoms, clinical data, and operative findings in a subgroup of patients.
METHODS
We evaluated physical examination, ultrasonographic findings, symptoms, and in a subgroup, the operative findings for Morton's neuroma. We analyzed the symptoms, the findings on physical examination, and ultrasonography data and performed a statistical correlation between them. A total of 175 patients were seen for suspected Morton's neuroma during the last 7 years.
RESULTS
Neuropathic pain of the toes was reported in 63% of patients. Presence of ultrasonographic findings suggesting Morton's neuroma was observed in 77% of cases. A mild significant relationship between neuropathic pain and positive ultrasonographic findings was observed. We found a strong correlation between ultrasonographic and clinical evaluation, but more than half with clinical negative Morton's neuroma had positive findings at ultrasonography. In the subgroup of operatively treated patients (n = 44) surgery confirmed Morton's neuroma in all patients who had positive ultrasonography findings.
CONCLUSIONS
The current study suggests that the association of ultrasonographic evaluation and clinical evaluation can be very useful for the management of Morton's neuroma. Our study could help with the development of a multiperspective approach in the diagnosis of Morton's neuroma.
LEVEL OF EVIDENCE
Level II, prospective cohort survey study.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cohort Studies; Female; Humans; Male; Middle Aged; Morton Neuroma; Neuralgia; Physical Examination; Prospective Studies; Surveys and Questionnaires; Ultrasonography; Young Adult
PubMed: 32856473
DOI: 10.1177/1071100720946748 -
Australian Family Physician Jun 1996Metatarsalgia, or pain in the metatarsal region of the foot, is a common orthopaedic problem, but is generally less well understood than pain in the toes, ankle or heel....
Metatarsalgia, or pain in the metatarsal region of the foot, is a common orthopaedic problem, but is generally less well understood than pain in the toes, ankle or heel. The cause of metatarsal pain is often less apparent than in other regions of the foot, and in many cases plain X-rays are of no help. Morton's neuroma, a common cause of severe metatarsalgia, can usually only be diagnosed from the history and clinical examination. The key to diagnosis in the metatarsal region is to have a clear knowledge of the most likely conditions.
Topics: Diagnosis, Differential; Female; Foot Diseases; Humans; Male; Metatarsus; Middle Aged; Pain
PubMed: 8687309
DOI: No ID Found -
Journal of Ultrasound in Medicine :... Apr 2019This study aims to evaluate the clinical importance of intermetatarsal distance, size of neuroma, and proportion of neuroma in the intermetatarsal space in examinations... (Observational Study)
Observational Study
OBJECTIVES
This study aims to evaluate the clinical importance of intermetatarsal distance, size of neuroma, and proportion of neuroma in the intermetatarsal space in examinations of Morton neuroma using ultrasonography.
METHODS
Clinical prognosis was observed prospectively after corticosteroid injections in 136 patients with Morton neuroma, and the results were compared with ultrasonographic parameters of intermetatarsal distance, size of neuroma, and proportion of neuroma in the intermetatarsal space.
RESULTS
Twenty-one patients (15%) did not respond to corticosteroid injections and underwent surgical treatment for Morton neuroma. Logistic regression analysis and receiver operating characteristic curve analysis showed that the size of the neuroma was the sole predictor of failure of corticosteroid injections (P = .002). No other factors were significant for the prediction of clinical prognosis (P > .05).
CONCLUSIONS
The size of the neuroma on ultrasonography is the sole predictor of corticosteroid injection failure, while intermetatarsal distance and proportion of neuroma in the intermetatarsal space are not significant when predicting clinical prognosis of Morton neuroma.
Topics: Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Female; Foot; Humans; Male; Middle Aged; Morton Neuroma; Prognosis; Prospective Studies; Severity of Illness Index; Treatment Outcome; Ultrasonography; Young Adult
PubMed: 30244477
DOI: 10.1002/jum.14787