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Orthopedics Jan 1987A number of new concepts in the pathology, diagnosis, and management of Morton's metatarsalgia have been presented in the recent literature. Probably as many questions... (Review)
Review
A number of new concepts in the pathology, diagnosis, and management of Morton's metatarsalgia have been presented in the recent literature. Probably as many questions as answers have been generated by these publications. The taut transverse metatarsal ligament appears to play a critical role compressing the interdigital nerve but the exact pathomechanics producing the neuroma and the role of the intermetatarsal bursa remain unclear. Electrodiagnostic techniques for this condition are in the early development stage and may be clinically applicable in the near future. Support for and recommendation against the preoperative injection of the intermetatarsal bursa and interdigital nerve area have been discussed. The necessity of interdigital neurectomy has been questioned but currently in North America, simple transverse metatarsal ligament division has not been widely utilized. Continued studies along these lines should improve our understanding of Morton's metatarsalgia, increase our diagnostic accuracy, and facilitate more effective management.
Topics: Bursa, Synovial; Female; Foot Diseases; Humans; Male; Metatarsus; Nerve Compression Syndromes; Neural Conduction; Neuralgia; Neuroma; Syndrome
PubMed: 3543897
DOI: 10.3928/0147-7447-19870101-18 -
Orthopedics Jan 2019Metatarsalgia can be viewed as more of a symptom rather than a distinct diagnosis. Timing of forefoot pain during the gait cycle and evaluation of whether the pain is... (Review)
Review
Metatarsalgia can be viewed as more of a symptom rather than a distinct diagnosis. Timing of forefoot pain during the gait cycle and evaluation of whether the pain is from anatomic abnormalities, indirect overloading, or iatrogenic causes can suggest a specific metatarsalgia etiology. A thorough physical examination of the lower extremity, especially evaluation of the plantar foot, and weight-bearing radiographs are critical for diagnosis and treatment. Nonoperative treatment consists of physical therapy, orthotics, shoe wear modification, and injections. If conservative treatment fails, surgical options may be considered. [Orthopedics. 2019; 42(1):e138-e143.].
Topics: Arthritis, Rheumatoid; Equinus Deformity; Foot; Fractures, Bone; Gout; Humans; Iatrogenic Disease; Metatarsal Bones; Metatarsalgia; Metatarsus; Morton Neuroma; Osteochondritis; Physical Examination; Psoriasis; Synovitis
PubMed: 30540873
DOI: 10.3928/01477447-20181206-06 -
Foot & Ankle International Oct 2020Morton's neuroma is a frequent cause of metatarsalgia. Operative treatment is indicated if nonoperative management has failed. The objective of the present study was to...
BACKGROUND
Morton's neuroma is a frequent cause of metatarsalgia. Operative treatment is indicated if nonoperative management has failed. The objective of the present study was to describe a technique of Morton's neuroma excision by a minimally invasive commissural approach and evaluate the long-term outcome and complications.
METHODS
A retrospective study of 108 patients with Morton's neuroma treated surgically with a commissural approach between September 1990 and December 2010 was performed. The surgical technique is described. Clinical outcomes and complications were evaluated. The average follow-up was 121 months. Eleven patients were men and 97 women. The average age was 49.4 years; 56.8% neuromas were at the third space and 43.2% at the second space. Six patients presented 2 neuromas in the same foot, and 9 patients had bilateral neuroma.
RESULTS
The visual analog scale (VAS) average pain score was 5.4 points preoperatively and 0.2 points at the final follow-up. The author found a significant difference between the VAS scores preoperatively and postoperatively ( < .01). Excellent and good satisfaction outcomes were achieved in 93.6%. The postoperative complication incidence was 3%.
CONCLUSION
The author believes a minimally invasive commissural approach has advantages over a dorsal or plantar incision. It is a simple and reproducible technique, with satisfactory outcomes, low complication rates, and a quick return to usual activities.
LEVEL OF EVIDENCE
Level IV, retrospective case series.
Topics: Adult; Female; Humans; Male; Metatarsalgia; Middle Aged; Morton Neuroma; Neuroma; Pain Measurement; Retrospective Studies
PubMed: 32674597
DOI: 10.1177/1071100720936599 -
JAMA Dec 2023Morton neuroma, plantar fasciitis, and Achilles tendinopathy are foot and ankle conditions that are associated with pain and disability, but they can respond to... (Review)
Review
IMPORTANCE
Morton neuroma, plantar fasciitis, and Achilles tendinopathy are foot and ankle conditions that are associated with pain and disability, but they can respond to nonoperative treatment.
OBSERVATIONS
Morton neuroma, consisting of interdigital neuronal thickening and fibrosis, is characterized by burning pain in the ball of the foot and numbness or burning pain that may radiate to the affected toes (commonly the third and fourth toes). First-line nonoperative therapy consists of reducing activities that cause pain, orthotics, and interdigital corticosteroid injection; however, approximately 30% of patients may not respond to conservative treatment. Plantar fasciitis accounts for more than 1 million patient visits per year in the US and typically presents with plantar heel pain. Fifteen years after diagnosis, approximately 44% of patients continue to have pain. First-line nonoperative therapy includes stretching of the plantar fascia and foot orthotics, followed by extracorporeal shockwave therapy, corticosteroid injection, or platelet-rich plasma injection. Midportion Achilles tendinopathy presents with pain approximately 2 to 6 cm proximal to the Achilles insertion on the heel. The primary nonoperative treatment involves eccentric strengthening exercises, but extracorporeal shockwave therapy may be used.
CONCLUSIONS AND RELEVANCE
Morton neuroma, plantar fasciitis, and Achilles tendinopathy are painful foot and ankle conditions. First-line therapies are activity restriction, orthotics, and corticosteroid injection for Morton neuroma; stretching and foot orthotics for plantar fasciitis; and eccentric strengthening exercises for Achilles tendinopathy.
Topics: Humans; Achilles Tendon; Adrenal Cortex Hormones; Ankle; Fasciitis, Plantar; Morton Neuroma; Pain; Tendinopathy; Foot
PubMed: 38112812
DOI: 10.1001/jama.2023.23906 -
World Journal of Radiology Sep 2018Among the many causes of forefoot pain, Morton's neuroma (MN) is often suspected, particularly in women, due to its high incidence. However, there remain controversies... (Review)
Review
Among the many causes of forefoot pain, Morton's neuroma (MN) is often suspected, particularly in women, due to its high incidence. However, there remain controversies about its relationship with symptomatology and which diagnostic and treatment choices to choose. This article mainly focuses on the role of the various imaging methods and their abilities to support an accurate diagnosis of MN, ruling out other causes of forefoot pain, and as a way of providing targeted imaging-guided therapy for patients with MN.
PubMed: 30310543
DOI: 10.4329/wjr.v10.i9.91 -
Journal of the American Podiatric... Feb 1993
Topics: Eponyms; Foot Diseases; Humans; Neuroma; Terminology as Topic
PubMed: 8478796
DOI: 10.7547/87507315-83-2-108 -
Foot & Ankle Specialist Aug 2013Morton's neuroma is a common condition mainly affecting middle aged women, and there are many proposed etiological theories involving chronic repetitive trauma,... (Review)
Review
Morton's neuroma is a common condition mainly affecting middle aged women, and there are many proposed etiological theories involving chronic repetitive trauma, ischemia, entrapment, and intermetatarsal bursitis. Incorrect terminology suggests that the underlying pathological process is a nerve tumor, although histological examination reveals the presence of inflammatory tissue-that is, perineural fibrosis. The common digital nerve and its branches in the third planter webspace are most commonly affected. Diagnosis is usually made through history taking and clinical examination but may be aided by ultrasonography and magnetic resonance imaging. Current nonoperative treatment strategies include shoe-wear modifications, custom made orthoses, and injections of local anesthetic agents, sclerosing agents, and steroids. Operative management options primarily involve either nerve decompression or neurectomy. We have reviewed the published literature to evaluate the outcomes of the available diagnostic modalities and treatment options and present an algorithm for clinical practice.
Topics: Decompression, Surgical; Diagnostic Imaging; Foot; Glucocorticoids; Humans; Injections, Intralesional; Nerve Block; Neuroma; Orthopedic Procedures; Pain; Peripheral Nervous System Neoplasms; Physical Examination
PubMed: 23811947
DOI: 10.1177/1938640013493464 -
Foot & Ankle Specialist Jun 2019When using a dorsal approach for Morton's neuroma excision, the most common complication is recurrent Morton's neuroma. The present cadaveric study demonstrates how far... (Comparative Study)
Comparative Study
BACKGROUND
When using a dorsal approach for Morton's neuroma excision, the most common complication is recurrent Morton's neuroma. The present cadaveric study demonstrates how far proximally the nerve is resected during a dorsal approach and examines both the laminar spreader and Gelpiretractor to determine which instrument facilitates maximal proximal resection of the nerve.
METHODS
This study involved 12 fresh-frozen cadaver specimens, each of which underwent a dorsal approach to the interdigital nerve with proximal resection. Either a laminar spreader or a Gelpi retractor was used to improve visualization of the intermetatarsal space. The interdigital nerve was then resected, and the lengths of the cut nerves were compared based on the retractor employed.
RESULTS
The mean length of proximal resection in the second intermetatarsal space was 2.42 cm when using the laminar spreader and 1.93 cm when using the Gelpi retractor (P = .252). In the third intermetatarsal space, the mean length of proximal resection was 2.14 cm when using the Laminar spreader and 1.48 cm when using the Gelpi retractor (P = .166).
CONCLUSION
This study demonstrates how far proximal the interdigital nerve is resected during a dorsal approach to Morton's neuroma and shows no statistically significant difference between the Laminar spreader and the Gelpi retractor. Level V: Cadaver study.
Topics: Cadaver; Humans; Metatarsal Bones; Morton Neuroma; Orthopedic Procedures
PubMed: 30111167
DOI: 10.1177/1938640018790013 -
The Cochrane Database of Systematic... 2004Morton's neuroma is a common, paroxysmal neuralgia affecting the web spaces of the toes, typically the third. The pain is often so debilitating that patients become... (Review)
Review
BACKGROUND
Morton's neuroma is a common, paroxysmal neuralgia affecting the web spaces of the toes, typically the third. The pain is often so debilitating that patients become anxious about walking or even putting their foot to the ground. Insoles, corticosteroid injections, excision of the nerve, transposition of the nerve and neurolysis of the nerve are commonly used treatments. Their effectiveness is poorly understood.
OBJECTIVES
To examine the evidence from randomised controlled trials concerning the effectiveness of interventions in adults with Morton's neuroma.
SEARCH STRATEGY
We searched the Cochrane Neuromuscular Disease Group trials register (searched January 2003), MEDLINE (January 1966 to January Week 2 2003), EMBASE (January 1980 to February Week 2 2003), and CINAHL (January 1982 to February Week 1 2003).
SELECTION CRITERIA
Randomised or quasi-randomised (methods of allocating participants to an intervention which were not strictly random e.g. date of birth, hospital record, number alternation) controlled trials of interventions for Morton's neuroma were selected. Studies where participants were not randomised into intervention groups were excluded.
DATA COLLECTION AND ANALYSIS
Two reviewers selected trials for inclusion in the review, assessed their methodological quality and extracted data independently.
MAIN RESULTS
Three trials involving 121 people were included. There is, at most, a very limited indication that transposition of the transected plantar digital nerve may yield better results than standard resection of the nerve in the long term. There is no evidence to support the use of supinatory insoles. There are, at best, very limited indications to suggest that dorsal incisions for resection of the plantar digital nerve may result in less symptomatic post-operative scars when compared to plantar excision of the nerve.
REVIEWERS' CONCLUSIONS
There is insufficient evidence with which to assess the effectiveness of surgical and non-surgical interventions for Morton's neuroma. Well designed trials are needed to begin to establish an evidence base for the treatment of Morton's neuroma pain.
Topics: Foot Diseases; Humans; Metatarsalgia; Neuroma; Randomized Controlled Trials as Topic; Toes
PubMed: 15266472
DOI: 10.1002/14651858.CD003118.pub2 -
Journal of Plastic, Reconstructive &... Jun 2020
Topics: Humans; Morton Neuroma; Nerve Compression Syndromes; Neuroma; Neurosurgical Procedures; Retrospective Studies
PubMed: 32178989
DOI: 10.1016/j.bjps.2020.02.037