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Current Opinion in Rheumatology Mar 2000Morton neuroma is most likely a mechanically-induced degenerative neuropathy that predilects the third common digital nerve in middle-aged women who frequently wear... (Review)
Review
Morton neuroma is most likely a mechanically-induced degenerative neuropathy that predilects the third common digital nerve in middle-aged women who frequently wear fashionable shoes that are not designed for the physiology of the foot. A compression test of the affected web space is quite specific for its diagnosis, and an ultrasonograph can tell its exact size. If conservative means fail to relieve the painful symptoms of a Morton neuroma, surgical removal can produce dramatic pain relief. Metatarsalgia means pain in the metatarsal head region, and exists in three general forms: metatarsalgia of the first metatarsal head region, metatarsalgia of the fourth lateral metatarsal head region, and generalized metatarsalgia. There are numerous causes of metatarsalgia; a selected and important group of causes is discussed in this article. When conservative means fail to relieve metatarsalgia, specific surgical operations are quite effective for relief of pain, and are briefly described in the text.
Topics: Female; Foot Deformities; Foot Diseases; Humans; Neuroma
PubMed: 10751016
DOI: 10.1097/00002281-200003000-00007 -
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 -
Foot and Ankle Surgery : Official... Apr 2018Morton's neuroma is one of the most common causes of metatarsalgia. Despite this, it remains little studied, as the diagnosis is clinical with no reliable instrumental... (Review)
Review
Morton's neuroma is one of the most common causes of metatarsalgia. Despite this, it remains little studied, as the diagnosis is clinical with no reliable instrumental diagnostics, and each study may deal with incorrect diagnosis or inappropriate treatment, which are difficult to verify. The present literature review crosses all key points, from diagnosis to surgical and nonoperative treatment, and recurrences. Nonoperative treatment is successful in a limited percentage of cases, but it can be adequate in those who want to delay or avoid surgery. Dorsal or plantar approaches were described for surgical treatment, both with strengths and weaknesses that will be scanned. Failures are related to wrong diagnosis, wrong interspace, failure to divide the transverse metatarsal ligament, too distal resection of common plantar digital nerve, an association of tarsal tunnel syndrome and incomplete removal. A deep knowledge of the causes and presentation of failures is needed to surgically face recurrences.
Topics: Foot; Humans; Metatarsalgia; Morton Neuroma; Recurrence
PubMed: 29409221
DOI: 10.1016/j.fas.2017.01.007 -
Acta Orthopaedica Et Traumatologica... 2002
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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 -
Foot (Edinburgh, Scotland) Dec 2020Morton's neuromas are benign lesions of the inter-digital nerves within the foot. They are most commonly found in the second and third webspace. Morton's neuroma of the... (Review)
Review
Morton's neuromas are benign lesions of the inter-digital nerves within the foot. They are most commonly found in the second and third webspace. Morton's neuroma of the first webspace is very rare. A case of a 42-year-old female who presented complaining of long standing forefoot pain is presented. The patient was diagnosed with a soft tissue tumor in the 1st webspace. An excisional biopsy of the tumour confirmed a Morton's neuroma. Very few cases of Morton's neuroma in the first webspace have been reported in the literature.
Topics: Adult; Female; Humans; Morton Neuroma
PubMed: 33039907
DOI: 10.1016/j.foot.2020.101723 -
EFORT Open Reviews Jan 2019The terminology 'Morton's neuroma' may represent a simplification of the clinical condition as the problem may not be a benign tumour of the nerve, but neuropathic foot...
The terminology 'Morton's neuroma' may represent a simplification of the clinical condition as the problem may not be a benign tumour of the nerve, but neuropathic foot pain associated with the interdigital nerve.Foot and ankle pathomechanics leading to metatarsalgia, clinical examination and differential diagnosis of the condition and imaging of the condition, for differential diagnosis, are discussed.Nonoperative management is recommended initially. Physiotherapy, injections (local anaesthetic, steroid, alcohol), cryotherapy, radiofrequency ablation and shockwave therapy are discussed.Operative treatment is indicated after nonoperative management has failed. Neuroma excision has been reported to have good to excellent results in 80% of patients, but gastrocnemius release and osteotomies should be considered so as to address concomitant problems.Key factors in the success of surgery are correct diagnosis with recognition of all elements of the problem and optimal surgical technique. Cite this article: 2019;4:14-24. DOI: 10.1302/2058-5241.4.180025.
PubMed: 30800476
DOI: 10.1302/2058-5241.4.180025 -
Clinics in Podiatric Medicine and... Jan 2021Morton's neuroma is a common painful pathology that occurs in the plantar forefoot. Many treatment options exist and surgical management is used after conservative... (Review)
Review
Morton's neuroma is a common painful pathology that occurs in the plantar forefoot. Many treatment options exist and surgical management is used after conservative treatment options fail. While within the literature, there is a high success rate with primary neurectomy procedures, the risk of recurrence of symptoms or "stump neuromas" remains difficult to treat and can lead to debilitating pain. This article expands on a previously published article to discuss an update on a nerve sparing, microneurosurgical, procedure for the management of Morton's neuromas.
Topics: Foot; Foot Diseases; Humans; Morton Neuroma; Neuroma; Pain
PubMed: 35101239
DOI: 10.1016/j.cpm.2021.07.002 -
Seminars in Musculoskeletal Radiology Jun 2023Lesser (or central) metatarsalgia is defined as pain in the forefoot under or around the lesser metatarsals and their respective metatarsophalangeal joints. Two common... (Review)
Review
Lesser (or central) metatarsalgia is defined as pain in the forefoot under or around the lesser metatarsals and their respective metatarsophalangeal joints. Two common causes of central metatarsalgia are Morton's neuroma (MN) and plantar plate (PP) injury. Because both clinical and imaging features overlap, establishing the correct differential diagnosis may be challenging. Imaging has a pivotal role in the detection and characterization of metatarsalgia. Different radiologic modalities are available to assess the common causes of forefoot pain, so the strengths and weakness of these imaging tools should be kept in mind. It is crucial to be aware of the pitfalls that can be encountered in daily clinical practice when dealing with these disorders. This review describes two main causes of lesser metatarsalgia, MN and PP injury, and their differential diagnoses.
Topics: Humans; Diagnosis, Differential; Metatarsalgia; Foot
PubMed: 37230133
DOI: 10.1055/s-0043-1764388