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European Radiology Aug 2015To compare ultrasound (US) and magnetic resonance imaging (MRI) in the diagnosis of Morton's neuroma. (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVES
To compare ultrasound (US) and magnetic resonance imaging (MRI) in the diagnosis of Morton's neuroma.
METHODS
Studies that assessed the diagnostic accuracy of US and MRI for Morton's neuroma were retrieved from major medical libraries independently by two reviewers up to 1 April 2014. Predefined inclusion and exclusion criteria were adopted.
RESULTS
277 studies were initially found, and the meta-analysis was conducted on 14 studies. US sensitivity was studied in five studies, MRI sensitivity in three studies, and bothin six studies. All studies used surgery as the reference standard. A high sensitivity (SE) of diagnostic testing was observed for both US (SE (95 % CI) = 0.91 (0.83-0.96)) and MRI (SE (95 % CI) = 0.90 (0.82-0.96)) with no significant differences between the two modalities in diagnosis (Q test p = 0.88). For MRI, specificity of test was 1.00 with a pooled estimation of 1.00 (0.73-1.00), while the pooled specificity was 0.854 (95 % CI: 0.41-1.00) for US. No differences were observed between US and MRI in study design (p = 0.76).
CONCLUSION
This meta-analysis shows that the SE of US (0.91) is equal to (p = 0.88) that of MRI (0.90) for identification of Morton's neuroma.
KEY POINTS
• For Morton's neuroma, US sensitivity is equal to MRI. • US is as accurate as MRI in diagnosing Morton's neuroma. • US may be the most cost-effective imaging method for Morton's neuroma.
Topics: Adult; Aged; Female; Foot Diseases; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuroma; Peripheral Nervous System Neoplasms; Sensitivity and Specificity; Ultrasonography
PubMed: 25809742
DOI: 10.1007/s00330-015-3633-3 -
The Journal of Foot and Ankle Surgery :... 1996Morton's neuroma is most likely a mechanically induced degenerative neuropathy which has a strong predilection for the third common digital nerve in middle-aged women.... (Review)
Review
Morton's neuroma is most likely a mechanically induced degenerative neuropathy which has a strong predilection for the third common digital nerve in middle-aged women. The excessive motion between the third and fourth metatarsals, the tethered third common digital nerve in the third web space, the third and fourth metatarsal heads flanking the third common digital nerve, the stout third transverse intermetatarsal ligament overlying the third common digital nerve, and excessive weightbearing stress on the forefoot, particularly by wearing pointed and high-heeled shoes, can collectively produce microdamage to the third common digital nerve. If allowed to continue for a long period of time, this can become manifested microscopically by nerve fiber degeneration and excessive intraneural and juxtaneural reparative fibrous tissue formation resulting in a significantly enlarged nerve. Such enlargement can create further trauma, and therefore become even more symptomatic. When nonsurgical means fail to relieve patient's symptoms, surgical removal of this offending neuroma through a dorsal approach can produce dramatic relief of symptoms. In addition, when a painful recurring Morton's neuroma does not respond to conservative treatments, removal of this lesion through a plantar approach can provide lasting relief.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Foot; Foot Diseases; Humans; Middle Aged; Neuroma; Recurrence
PubMed: 8722878
DOI: 10.1016/s1067-2516(96)80027-5 -
Clinics in Podiatric Medicine and... Jul 1997The goal of the physician treating the athlete with Morton's neuroma should be the same as the goal of the athlete. This is to relieve the pain while allowing the... (Review)
Review
The goal of the physician treating the athlete with Morton's neuroma should be the same as the goal of the athlete. This is to relieve the pain while allowing the athlete to continue with his or her activity as much as possible. Therefore, conservative therapy should be stressed. If it fails, all surgical methods, including the EDIN procedure, and their disadvantages should be considered before choosing to undertake one.
Topics: Foot; Foot Diseases; Humans; Neuroma; Sports
PubMed: 9257036
DOI: No ID Found -
Clinics in Orthopedic Surgery Jun 2021This review aimed to evaluate the effects of corticosteroid injections on Morton's neuroma using an algorithmic approach to assess the methodological quality of reported...
BACKGROUD
This review aimed to evaluate the effects of corticosteroid injections on Morton's neuroma using an algorithmic approach to assess the methodological quality of reported studies using a structured critical framework.
METHODS
Several electronic databases were searched for articles published until April 2020 that evaluated the outcomes of corticosteroid injections in patients diagnosed with Morton's neuroma. Data search, extraction, analysis, and quality assessments were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). guidelines, and clinical outcomes were evaluated using various outcome measures.
RESULTS
With 3-12 months of follow-up, corticosteroid injections provided satisfactory outcomes according to Johnson satisfaction scores except in two studies. Visual analog scale scores showed maximal pain reduction between 1 week and 3 months after injection. We found that 140 subjects out of 469 (29.85%) eventually underwent surgery after receiving corticosteroid injections due to persistent pain.
CONCLUSIONS
Corticosteroid injections showed a satisfactory clinical outcome in patients with Morton's interdigital neuroma although almost 30% of the included subjects eventually underwent operative treatment. Our recommendation for future research includes using more objective outcome parameters, such as foot and ankle outcome scores or foot and ankle ability measures. Moreover, studies on the safety and effectiveness of multiple injections at the same site are highly necessary.
Topics: Adrenal Cortex Hormones; Disability Evaluation; Humans; Injections, Intralesional; Morton Neuroma; Pain Measurement; Patient Satisfaction; Surveys and Questionnaires
PubMed: 34094019
DOI: 10.4055/cios20256 -
AJR. American Journal of Roentgenology Sep 2000We determined the prevalence of clinically silent Morton's neuroma and searched for distinguishing MR imaging features of Morton's neuroma in patients with clinical...
OBJECTIVE
We determined the prevalence of clinically silent Morton's neuroma and searched for distinguishing MR imaging features of Morton's neuroma in patients with clinical complaints related to this entity and in patients with clinically silent lesions.
MATERIALS AND METHODS
One radiologist who was unaware of clinical findings retrospectively reviewed 85 consecutive foot MR examinations. MR imaging criteria for Morton's neuroma included a low- to intermediate-signal-intensity soft-tissue mass in the intermetatarsal space. The size, location, and signal intensity of each neuroma and the presence of intermetatarsal bursae were recorded. The patients were subdivided into symptomatic or asymptomatic groups on the basis of the patients' answers on a questionnaire documenting the locations and characteristics of symptoms and discussions with each referring physician about clinical findings. Surgical confirmation was available in eight of 25 symptomatic patients.
RESULTS
The prevalence of Morton's neuroma in patients with no clinical evidence of this condition was 33% (19/57). Twenty-five patients had symptomatic Morton's neuroma, 19 had Morton's neuroma based on MR imaging findings with no clinical manifestations, and 41 did not have Morton's neuroma. Slightly larger lesions were observed in the symptomatic group, although significant overlap was noted between the two groups. The mean transverse diameter of symptomatic neuromas was 5.3 mm (standard deviation, 2.14) compared with 4.1 mm (standard deviation, 1.75) for asymptomatic neuromas; this difference was marginally significant (p = 0.05).
CONCLUSION
The MR imaging diagnosis of Morton's neuroma does not imply symptomatology. Careful correlation between clinical and MR imaging findings is mandatory before Morton's neuroma is considered clinically relevant.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Female; Foot; Humans; Magnetic Resonance Imaging; Middle Aged; Neuroma; Retrospective Studies
PubMed: 10954445
DOI: 10.2214/ajr.175.3.1750649 -
Clinics in Podiatric Medicine and... Oct 1994Interdigital neuroma, more classically referred to as Morton's neuroma, is considered one of the most common nerve problems affecting the foot. In this article,...
Interdigital neuroma, more classically referred to as Morton's neuroma, is considered one of the most common nerve problems affecting the foot. In this article, information regarding intermetatarsal neuroma is presented according to both a historical and clinical perspective. In addition, the author presents his own research on neuromas and describes conservative and surgical approaches in a logical format.
Topics: Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Female; Foot; Foot Diseases; Humans; Male; Metatarsus; Methods; Middle Aged; Neuroma
PubMed: 7812904
DOI: No ID Found -
Indian Journal of Orthopaedics 2017Morton's neuroma is a common cause of metatarsalgia and many treatments had been described in literature. However, there have been only a few reports that treat the...
BACKGROUND
Morton's neuroma is a common cause of metatarsalgia and many treatments had been described in literature. However, there have been only a few reports that treat the neuroma with an osteotomy on the proximal, not distal portion of the metatarsal bone using a plate. This study describes the clinical outcome of sliding osteotomy on the proximal metatarsal bone for the treatment of Morton's neuroma.
MATERIALS AND METHODS
Sixty five consecutive patients (85 feet) who underwent surgery for Morton's neuroma between November 2010 and February 2013 were identified from hospital records to include in this retrospective study. Average followup period was 37.3 months (range 24-51 months). Mean patient age at surgery was 50.2 years (range 23-75 years). Metatarsal sliding osteotomies were only performed on the third metatarsal bone. Clinical evaluations with the American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal Interphalangeal Scale (AOFAS LMIS) and Foot Function Index (FFI) were performed. The length of the lesser toe was measured for radiologic evaluation.
RESULTS
Postoperatively, AOFAS LMIS and FFI were improved from 52.1 (range 45-60) and 62.4 (range 54-73) to 74.2 (range 68-86) and 31.3 (range 26-37). At the last followup, preoperative pain was dissolved in 79 feet (93% of overall 85 feet). A shortened 3.2 mm (±1.1) metatarsal bone following osteotomy was radiographically measured. There were six cases of complications (soft tissue infection, early numbness, delayed union, limitation of dorsiflexion and metal failure, etc.).
CONCLUSIONS
This proximal metatarsal sliding osteotomy can be a relatively effective operative method in relieving pain from Morton's neuroma.
PubMed: 29200487
DOI: 10.4103/0019-5413.217678 -
Plastic and Reconstructive Surgery.... Jan 2022Morton's neuroma (MN) is a painful, proliferative fibrosis of perineural tissue caused by pressure or recurrent irritation that was previously thought to affect only the...
Morton's neuroma (MN) is a painful, proliferative fibrosis of perineural tissue caused by pressure or recurrent irritation that was previously thought to affect only the common interdigital nerve of the foot. We present a case of a bilateral MN of both the ulnar and radial proper digital nerves of the fifth finger in a 30-year-old patient, following multiple surgeries on the aforementioned finger. The patient was referred to our center by a peripheral hospital after traumatic fingertip amputation distal the DIP joint, where the fingertip was initially simply sutured. Because of progressive neuropathic pain, he underwent two revision surgeries, in which the distal phalanx was removed, two neuromas were excised, and the nerve stumps were shortened, but both were unsuccessful. A final, more extensive revision surgery was then carried out, in which two club-like enlargements were excised and the nerve stumps coadapted to form a loop. Histopathological examination of the excised specimen revealed perineural fibrosis in the context of a Morton's neuroma. This is, to our knowledge, the first documented case of a bilateral MN of the hand, which may have resulted from an inadequate primary finger and nerve shortening, resulting in high pressure from the surrounding soft tissue. Finally, this report emphasizes the significance of optimal treatment for finger amputation injuries, as well as the fact that for neuromas, simple nerve resection should be avoided whenever possible, because of the high recurrence rates.
PubMed: 35186616
DOI: 10.1097/GOX.0000000000004035 -
Acta Neurochirurgica Feb 2021Individual evidence suggests that multiple modalities can be used to treat entrapment pathology by Morton's neuroma, including injection, neurolysis, and neurectomy.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Individual evidence suggests that multiple modalities can be used to treat entrapment pathology by Morton's neuroma, including injection, neurolysis, and neurectomy. However, their impacts on patient pain and satisfaction have yet to be fully defined or elucidated. Correspondingly, our aim was to pool systematically identified metadata and substantiate the impact of these different modalities in treating Morton's neuroma with respect to these outcomes.
METHODS
Searches of 7 electronic databases from inception to October 2019 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. The incidences of outcomes were extracted and pooled by random-effects meta-analysis of proportions.
RESULTS
A total of 35 articles satisfied all criteria, reporting a total of 2998 patients with Morton's neuroma managed by one of the three modalities. Incidence of complete pain relief after injection (43%; 95% CI, 23-64%) was significantly lower than neurolysis (68%; 95% CI, 51-84%) and neurectomy (74%; 95% CI, 66-82%) (P = 0.02). Incidence of complete satisfaction after injection (35%; 95% CI, 21-50%) was significantly lower than neurolysis (63%; 95% CI, 50-74%) and neurectomy (57%; 95% CI, 47-67%) (P < 0.01). The need to proceed to further surgery was significantly greater following injection (15%; 95% CI, 9-23%) versus neurolysis (2%; 95% CI, 0-4%) or neurectomy (5%; 95% CI, 3-7%) (P < 0.01). Incidence of procedural complications did not differ between modalities (P = 0.30).
CONCLUSIONS
Although all interventions demonstrated favorable procedural complication incidences, surgical interventions by either neurolysis or neurectomy appear to trend towards greater incidences of complete pain relief and complete patient satisfaction outcomes compared to injection treatment. The optimal decision-making algorithm for treatment for Morton's neuroma should incorporate these findings to better form and meet the expectations of patients.
Topics: Denervation; Humans; Injections; Morton Neuroma; Nerve Block; Patient Satisfaction; Retrospective Studies
PubMed: 32056015
DOI: 10.1007/s00701-020-04241-9 -
The Journal of Foot and Ankle Surgery :... 2022Longitudinal plantar approaches are generally considered at risk for wound healing problems. Thus, we wanted to investigate long-term outcomes after a primary Morton's...
Longitudinal plantar approaches are generally considered at risk for wound healing problems. Thus, we wanted to investigate long-term outcomes after a primary Morton's neuroma excision through a longitudinal plantar approach. A retrospective study of patients with primary neuroma excision was conducted. Twenty-four patients (28 feet) were evaluated at a mean 9-year follow-up (range, 6-14) by a single trained examiner using a specific postoperative evaluation protocol, including AOFAS Forefoot subjective and objective scores. Good-to-excellent outcomes were reported in 25 (89.3%) cases. A hypertrophic scar formation and keratosis occurred in only 2 cases (7.1%). All the patients, with a single exception, achieved full weightbearing with a postoperative shoe from the first day after the operation. A longitudinal plantar approach can lead to long-term, good-to-excellent outcomes with no case of recurrence or reoperation. Accurate wound closure and immediate weightbearing with a postoperative shoe can minimize the rate of complications. This approach should be considered for primary resection of Morton's neuromas.
PubMed: 34782249
DOI: 10.1053/j.jfas.2021.10.010