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Radiologic Clinics of North America Nov 2018Although causes of metatarsalgia are multifactorial, in practice these most commonly include osseous stress reaction or fracture (including subchondral injury) and... (Review)
Review
Although causes of metatarsalgia are multifactorial, in practice these most commonly include osseous stress reaction or fracture (including subchondral injury) and interdigital neuroma or plantar plate tear with adjacent pseudoneuroma. The various roles of radiography, ultrasonography, and MR imaging are discussed, and relevant technical issues and imaging findings are reviewed in order to facilitate accurate diagnosis and guide proper treatment of metatarsalgia.
Topics: Athletic Injuries; Diagnosis, Differential; Fractures, Bone; Humans; Metatarsalgia; Risk Factors; Sensitivity and Specificity
PubMed: 30322488
DOI: 10.1016/j.rcl.2018.06.004 -
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 -
Brain and Nerve = Shinkei Kenkyu No... Dec 2014Morton's disease refers to neuralgia at the web space of the toes with a pseudo-neuroma. It commonly occurs in the third web space of the foot in middle-aged and older... (Review)
Review
Morton's disease refers to neuralgia at the web space of the toes with a pseudo-neuroma. It commonly occurs in the third web space of the foot in middle-aged and older women. The pseudo-neuroma is thought to be a secondary change after entrapment or repeated microtrauma. Patients complain of forefoot pain while walking. Typically, symptoms are caused by tight high-heeled shoes. The physical examination includes palpation of the web spaces and Mulder's test. Weight bearing foot radiographs are used to evaluate the deformity of the foot, especially at metatarsophalangeal (MTP) joints. MRI is useful for differential diagnosis of pseudo-neuroma, MTP joint arthritis, and interdigital bursitis. Conservative treatments are shoe modification, use of orthotic insoles, and injection of corticosteroids and local anesthesia. The injections are useful not only for the treatment but also for diagnosis of Morton's disease. If the local injection is not temporally effective, surgical treatment is not indicated. If the conservative treatment fails, surgical treatment is indicated. The most common surgery is excision of the pseudo-neuroma. The surgery is usually performed using a dorsal approach.
Topics: Foot; Humans; Joint Diseases; Magnetic Resonance Imaging; Metatarsophalangeal Joint; Neuralgia; Neuroma; Pain; Treatment Outcome
PubMed: 25475032
DOI: 10.11477/mf.1416200059 -
Radiographics : a Review Publication of... 2015The anatomy of the nerves of the foot and ankle is complex, and familiarity with the normal anatomy and course of these nerves as well as common anatomic variants is... (Review)
Review
The anatomy of the nerves of the foot and ankle is complex, and familiarity with the normal anatomy and course of these nerves as well as common anatomic variants is essential for correct identification at imaging. Ultrasonography (US) and magnetic resonance (MR) imaging allow visualization of these nerves and may facilitate diagnosis of various compression syndromes, such as "jogger's heel," Baxter neuropathy, and Morton neuroma. It may be difficult to distinguish the nerves from adjacent vasculature at MR imaging, and US can help in differentiation. The authors review the normal anatomy and common variants of the nerves of the foot and ankle, with use of dissected specimens and correlative US and MR imaging findings. In addition, the authors illustrate proper probe positioning, which is essential for visualizing the nerves at US. The authors' discussion focuses on the superficial and deep peroneal, sural, saphenous, tibial, medial and lateral plantar, medial and inferior calcaneal, common digital, and medial proper plantar digital nerves.
Topics: Ankle; Artifacts; Foot; Humans; Magnetic Resonance Imaging; Nerve Compression Syndromes; Peroneal Nerve; Sural Nerve; Tibial Nerve; Ultrasonography
PubMed: 26284303
DOI: 10.1148/rg.2015150028 -
ANZ Journal of Surgery Sep 2010
Review
Topics: Catheter Ablation; Foot Diseases; Humans; Neuroma; Toes; Treatment Outcome
PubMed: 20857612
DOI: 10.1111/j.1445-2197.2010.05401.x -
Clinics in Podiatric Medicine and... Apr 1997The diagnosis of Morton's neuroma is usually made from evaluation of a patient's subjective complaints, clinical findings, and exclusion of other differential diagnoses.... (Review)
Review
The diagnosis of Morton's neuroma is usually made from evaluation of a patient's subjective complaints, clinical findings, and exclusion of other differential diagnoses. Occasionally, when other neurological conditions exist or when the clinical findings are atypical, various imaging techniques may be helpful in the diagnosis of interdigital neuromas. This article will discuss these techniques and briefly review this common lower extremity disorder.
Topics: Foot Diseases; Humans; Magnetic Resonance Imaging; Neuroma; Radiography; Ultrasonography
PubMed: 9135905
DOI: No ID Found -
International Orthopaedics Dec 2022The optimal treatment of symptomatic Morton's neuroma remains unclear; conservative methods are sometimes ineffective and neurectomy has significant rates of patient...
Treatment of Morton's neuroma with minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) and percutaneous release of the deep transverse metatarsal ligament (DTML): a case series with minimum two-year follow-up.
BACKGROUND
The optimal treatment of symptomatic Morton's neuroma remains unclear; conservative methods are sometimes ineffective and neurectomy has significant rates of patient dissatisfaction. The aim of this study was to evaluate the outcome of minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) and percutaneous release of the deep transverse metatarsal ligament (DTML) in patients with Morton's neuroma.
METHODS
Between January 2018 and November 2019, 27 patients (29 feet) diagnosed with Morton's neuroma after clinical and radiological evaluation underwent DMMO and percutaneous DTML release. The primary clinical outcomes were pain (VAS) and function (AOFAS score). Secondary outcomes included patient satisfaction, complications, and radiographic outcomes. Patients were followed up for a minimum of two years.
RESULTS
The median age of the participants was 66 years (range 48-79) and the follow-up time was 28 months (24-47). There was a decrease of 5.7 points in the VAS for pain (p < .001) and an increase of 19.9 in AOFAS (p < .001) after the surgical procedure. There was one case of superficial infection and one patient required resection of the neuroma (neurectomy). The majority of patients (89.7%) were satisfied and considered the procedure outcome as excellent or good.
CONCLUSION
Treatment of Morton's neuroma with minimally invasive distal metatarsal metaphyseal osteotomy and percutaneous release of the deep transverse metatarsal ligament showed significant improvement in pain and function with a low incidence of complications and a high rate of personal satisfaction.
Topics: Humans; Child, Preschool; Child; Metatarsal Bones; Morton Neuroma; Follow-Up Studies; Osteotomy; Pain; Ligaments
PubMed: 36031662
DOI: 10.1007/s00264-022-05557-0 -
Clinical Orthopaedics and Related... 1977In a series of 25 patients (predominantly women) with Morton's metatarsalgia, the most likely site for a neuroma is the third cleft of the left foot. If a swelling is...
In a series of 25 patients (predominantly women) with Morton's metatarsalgia, the most likely site for a neuroma is the third cleft of the left foot. If a swelling is present or if radiographic examination shows toe divergence then the diagnosis in unlikely to be a simple digital neuroma. A review of the literature suggests that there are other causes of pain in the forefoot. Usually the pain is diffuse by when it is localized, Morton's metatarsalgia is diagnosed. However, causes other than a digital neuroma, e.g. traumatic bursitis and rheumatoid arthritis, epithelial cyst, and foreign body should be borne in mind.
Topics: Adult; Aged; Female; Foot Diseases; Humans; Male; Metatarsus; Middle Aged; Neuralgia; Neuroma; Syndrome
PubMed: 912981
DOI: No ID Found -
Foot & Ankle Specialist Feb 2022Despite multiple surgical modalities available for the management of Morton's neuroma, complications remain common. Targeted muscle reinnervation (TMR) has yet to be...
BACKGROUND
Despite multiple surgical modalities available for the management of Morton's neuroma, complications remain common. Targeted muscle reinnervation (TMR) has yet to be explored as an option for the prevention of recurrence of Morton's neuroma. The purpose of the present investigation was to determine the consistency of the relevant foot neurovascular and muscle anatomy and to demonstrate the feasibility of TMR as an option for Morton's neuroma.
METHODS
The anatomy of 5 fresh-tissue donor cadaver feet was studied, including the course and location of the medial and lateral plantar nerves (MPNs and LPNs), motor branches to abductor hallucis (AH) and flexor digitorum brevis (FDB), as well as the course of sensory plantar digital nerves. Measurements for the locations of the muscular and sensory branches were taken relative to landmarks including the navicular tuberosity (NT), AH, FDB, and the third metatarsophalangeal joint (third MTPJ).
RESULTS
The mean number of nerve branches to FDB identified was 2. These branch points occurred at an average of 8.6 cm down the MPN or LPN, 9.0 cm from the third MTPJ, 3.0 cm distal to AH distal edge, and 4.8 cm from the NT. The mean number of nerves to AH was 2.2. These branch points occurred at an average of 6.3 cm down the MPN, 11.9 cm from the third MTPJ, 0.8 cm from the AH distal edge, and 3.8 cm from the NT.
CONCLUSIONS
Recurrent interdigital neuroma, painful scar, and neuropathic pain are common complications of operative management for Morton's neuroma. Targeted muscle reinnervation is a technique that has demonstrated efficacy for the prevention and treatment of neuroma, neuropathic pain, and phantom limb pain in amputees. Herein, we have described the neuromuscular anatomy for the application of TMR for the management of Morton's neuroma. Target muscles, including the AH and FDB, have consistent innervation patterns in the foot, and consequently, TMR represents a viable option to consider for the management of recalcitrant Morton's neuroma.
LEVELS OF EVIDENCE
V.
Topics: Feasibility Studies; Foot; Foot Diseases; Humans; Morton Neuroma; Muscles; Neuroma
PubMed: 34854338
DOI: 10.1177/19386400211002702 -
Foot and Ankle Surgery : Official... Dec 2019The purpose of this study was to investigate and compare the clinical outcomes of dorsal suspension with those of neurectomy for the treatment of Morton's neuroma. (Comparative Study)
Comparative Study
BACKGROUND
The purpose of this study was to investigate and compare the clinical outcomes of dorsal suspension with those of neurectomy for the treatment of Morton's neuroma.
METHODS
We conducted a retrospective study of dorsal suspension and neurectomy group. The dorsal suspension was performed by dorsal transposition of neuroma over the dorsal transverse ligament after neurolysis. The visual analog scale (VAS), the Foot and Ankle Ability Measure (FAAM), postoperative satisfaction, and complications were evaluated.
RESULTS
Both groups reported significant pain relief, and there were no significant differences between the groups with respect to postoperative pain. The postoperative FAAM outcomes showed no significant between-group differences. Satisfaction analysis showed 'excellent' and 'good' results in the dorsal suspension and neurectomy groups (95% and 77.7%, respectively). Complications of numbness and paresthesia reported in the dorsal suspension group (5% and 5%, respectively) were significantly fewer than those of neurectomy group (61.1% and 33.3%, respectively) (both, p<.05).
CONCLUSIONS
With its favorable results, dorsal suspension can be another operative option for the treatment of Morton's neuroma.
LEVEL OF EVIDENCE
Level III, retrospective comparative case series.
Topics: Adult; Aged; Decompression, Surgical; Denervation; Female; Humans; Ligaments, Articular; Male; Middle Aged; Morton Neuroma; Nerve Block; Patient Satisfaction; Retrospective Studies; Visual Analog Scale
PubMed: 30342917
DOI: 10.1016/j.fas.2018.09.004