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Clinical Radiology Apr 2015To determine the accuracy of MRI versus ultrasound for Morton's neuroma. (Meta-Analysis)
Meta-Analysis Review
AIM
To determine the accuracy of MRI versus ultrasound for Morton's neuroma.
MATERIALS AND METHODS
A search was undertaken for clinical studies published in any language in PubMed up to the date of December 2013. Studies assessing the accuracy of the ultrasound or MRI for the diagnosis of Morton's neuroma were included. Data were pooled for meta-analysis. Study selection, data collection, and extraction were performed independently by two authors. Meta-disc 1.4 and Revman 5.2 software were applied for statistical analysis.
RESULTS
The study included 12 studies; 217 patients underwent MRI and 241 underwent ultrasound examinations. There appeared greater diagnostic accuracy for ultrasound than MRI for the diagnosis of Morton's neuroma (ultrasound sensitivity 90%, specificity 88%, positive likelihood ratio 2.77, negative likelihood ratio 0.16 versus MRI sensitivity 93%, specificity 68%, positive likelihood ratio 1.89, negative likelihood ratio 0.19).
CONCLUSIONS
The available evidence suggests that ultrasound can provide better accuracy for the diagnosis of Morton's neuroma than MRI.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Foot Diseases; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuroma; Reproducibility of Results; Sensitivity and Specificity; Ultrasonography; Young Adult
PubMed: 25466436
DOI: 10.1016/j.crad.2014.10.017 -
Seminars in Musculoskeletal Radiology Dec 2022Magnetic resonance imaging (MRI) is a robust method used for both preoperative and postoperative evaluation of Morton's neuroma and other neural lesions. MRI is used to...
Magnetic resonance imaging (MRI) is a robust method used for both preoperative and postoperative evaluation of Morton's neuroma and other neural lesions. MRI is used to confirm the diagnosis and for precise localization, estimation of outcome, and differential diagnoses. The differential diagnoses include mechanically induced plantar plate ruptures with associated Morton's neuroma-like tumors in the intermetatarsal/interdigital spaces; mechanical fibrosis cushion formations and pseudo bursae in the plantar foot adipose tissue; rheumatologic affections, such as rheumatoid nodules, gouty nodules, and intermetatarsal bursitis; and lastly the tenosynovial giant cell tumor (formerly called pigmented villonodular synovitis). In the postoperative evaluation after resection of Morton's neuroma, the same differential diagnoses must be considered as in the preoperative evaluation. Similarly, a high prevalence (up to 25%) of asymptomatic Morton's neuroma-like findings in the intermetatarsal and interdigital spaces should be kept in mind when interpreting postoperative recurrent forefoot pain after Morton's neuroma resection.
Topics: Humans; Morton Neuroma; Neuroma; Foot; Foot Diseases; Peripheral Nervous System Neoplasms
PubMed: 36791739
DOI: 10.1055/s-0042-1760212 -
Journal of the American Podiatric... Jul 2014Morton's neuroma is a frequently painful condition of the forefoot, causing patients to seek medical care to alleviate symptoms. A plethora of therapeutic options is... (Review)
Review
BACKGROUND
Morton's neuroma is a frequently painful condition of the forefoot, causing patients to seek medical care to alleviate symptoms. A plethora of therapeutic options is available, some of which include injection therapies. Researchers have investigated injection therapy for Morton's neuroma, and latterly the evidence base has been augmented with methods that use diagnostic ultrasound as a vehicle to deliver the injectate under image guidance for additional accuracy. To date, there seems to be no consensus that ultrasound-guided injections provide better therapeutic outcomes than nonguided injections for the treatment of Morton's neuroma.
METHODS
A systematic review was chosen because this method can undertake such a process. The review process identified 13 key papers using predetermined inclusion and exclusion criteria, which then underwent methodological quality assessment using a pretested Quality Index. A narrative synthesis of the review findings is presented in light of the heterogeneity of the data from the extraction process.
RESULTS
This systematic review provides an argument that ultrasound guidance can produce better short- and long-term pain relief for corticosteroid injections, can reduce the need for additional procedures in a series of sclerosing alcohol injections, can reduce the surgical referral rate, and can add efficacy to a single injection.
CONCLUSIONS
Ultrasound guidance should be considered for injection therapy in the management of Morton's neuroma.
Topics: Forefoot, Human; Glucocorticoids; Humans; Injections, Intralesional; Neuroma; Peripheral Nervous System Neoplasms; Sclerosing Solutions; Ultrasonography, Interventional
PubMed: 25076076
DOI: 10.7547/0003-0538-104.4.337 -
Orthopedics Nov 1984In this series, 27 patients underwent surgery for recurrent Morton's neuroma through a plantar incision. All patients were women, with an age range of 35 to 65 years....
In this series, 27 patients underwent surgery for recurrent Morton's neuroma through a plantar incision. All patients were women, with an age range of 35 to 65 years. Followup ranged from 12 months to three years. Twenty-one patients had recurrent neuromas in the third intermetatarsal space, and six patients had recurrence in the second intermetatarsal space.Twenty-four of 27 patients had excellent or good results, a success rate of 89%. Three patients with poor results had undergone previous surgery, including metatarsal osteotomies and adjacent nerve exploration, with resultant fat pad atrophy and chronic metatarsalgia. None of the patients developed a painful plantar scar. Stress fractures of the third metatarsal were not seen. Normal shoe wear and activity returned at six to 12 weeks in those patients with a satisfactory result.
PubMed: 24823151
DOI: 10.3928/0147-7447-19841101-09 -
Foot and Ankle Surgery : Official... Jun 2022The effectiveness of operative treatments other than neurectomy for Morton's neuroma remains debatable despite several reported studies. This review aimed to evaluate...
BACKGROUND
The effectiveness of operative treatments other than neurectomy for Morton's neuroma remains debatable despite several reported studies. This review aimed to evaluate the effects of operative treatments for Morton's neuroma other than neurectomy using an algorithmic approach and a structured critical framework to assess the methodological quality of reported studies.
METHODS
Several electronic databases were searched for articles published until August 2021 that evaluated the outcomes of operative treatments other than neurectomy in patients diagnosed with Morton's neuroma. Data searches, extraction, analysis, and quality assessments were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the clinical outcomes were evaluated using objective, subjective, and negative outcomes; complications; and reoperation rate and type.
RESULTS
After reviewing 11,213 studies, 22 studies were finally included. Although a number of studies with high level of evidence are limited, we divided them according to four categories: (1) neurolysis with or without nerve transposition, (2) minimally invasive nerve decompression, (3) metatarsal osteotomy, and (4) additional procedures after nerve transection or neurectomy. All categories showed reliable outcomes except minimally invasive nerve decompression. The proportion of postoperative neurogenic symptoms was lower with neurolysis than with neurectomy.
CONCLUSION
Whether the alternative procedures were superior to neurectomy remains unclear as the number of good quality studies was limited. The proportion of postoperative neurogenic symptoms was lower with neurolysis than with neurectomy. Furthermore, performing simultaneous dorsal transposition of the nerve along with neurolysis is more recommended than neurolysis alone. Surgeons should be more careful with minimally invasive deep transverse intermetatarsal ligament release and metatarsal shortening osteotomy as their effectiveness remains inconclusive. Finally, we strongly recommend performing intramuscular embedding or intermuscular transposition of the nerve cutting end if neurectomy or nerve transection is inevitable.
LEVEL OF EVIDENCE
Level III, systematic review.
Topics: Denervation; Foot; Foot Diseases; Humans; Morton Neuroma; Neuroma; Osteotomy
PubMed: 34736848
DOI: 10.1016/j.fas.2021.10.011 -
American Journal of Surgery Mar 1949
Topics: Humans; Neoplasms; Neuralgia; Neuroma; Peripheral Nerves; Toes
PubMed: 18111700
DOI: 10.1016/0002-9610(49)90172-5 -
BMC Musculoskeletal Disorders Oct 2022Morton's neuroma is a painful enlargement of the plantar digital nerve between the metatarsal heads that causes pain of the forefoot. Several approaches have been used...
BACKGROUND
Morton's neuroma is a painful enlargement of the plantar digital nerve between the metatarsal heads that causes pain of the forefoot. Several approaches have been used to treat Morton's neuroma, each of them having distinct advantages and disadvantages.
OBJECTIVES
The purpose of this study was to investigate and compare the clinical outcomes of neurectomy in the treatment of Morton's neuroma through plantar and dorsal approaches.
MATERIALS AND METHODS
A total of 20 patients with a mean age of 48.5 ± 13.0 years (range: 19-66 years) who underwent excision of a Morton's neuroma that did not respond to conservative treatment were retrospectively analysed from June 2014 to June 2021. All the neurectomies were performed using a plantar or dorsal approach. Outcomes were evaluated using visual analogue scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, the Foot and Ankle Ability Measure (FAAM), and complications. The appearance index (AI) was also used to assess the influence of foot appearance on the quality of life after surgery.
RESULTS
Eight patients underwent neurectomy by the dorsal approach, and 12 patients underwent neurectomy by the plantar approach. The average follow-up time was 28.9 ± 12.9 months (range: 15-72 months). No statistically significant difference was found between the dorsal and plantar approach groups with respect to postoperative pain measured by the VAS score. The postoperative AOFAS scores and FAAM outcomes were not significantly different between the groups. The complications reported in the dorsal approach group were significantly less than those of the plantar group, mainly discomfort in wearing shoes. The AI of the plantar group and the dorsal group were significantly different.
CONCLUSION
The excision of the Morton's neuroma by both the dorsal and plantar approach resulted in satisfactory outcomes. However, the foot appearance after surgery by the plantar approach had less influence on the quality of life than that using the dorsal approach. Our recommendation is that surgeons should choose the approach they are most familiar with and with which they are most confident in performing. In addition, the plantar approach is recommended if the patient needs a better appearance.
Topics: Adult; Humans; Metatarsal Bones; Middle Aged; Morton Neuroma; Pain, Postoperative; Quality of Life; Retrospective Studies
PubMed: 36203146
DOI: 10.1186/s12891-022-05858-w -
Foot & Ankle International May 2020Morton's neuroma is a common cause of forefoot pain. Various conservative methods (injections of various pharmacologic agents) have been published with an outcome of...
BACKGROUND
Morton's neuroma is a common cause of forefoot pain. Various conservative methods (injections of various pharmacologic agents) have been published with an outcome of 6%-75% success rate (free of pain in daily life) per injection. The aim of the present study was to assess the outcome of an improved localization technique, a higher dosage, and a higher percentage of ethanol.
METHODS
Using fluoroscopic and electroneurographic guidance, 2.5 mL of 70% ethanol were injected into 33 feet with a magnetic resonance imaging (MRI)-verified neuroma. We evaluated patients at up to 5-year follow-up.
RESULTS
A "success rate" of more than 82% per single injection (defined as free of pain in daily life) was achieved and no recurrence was seen over 5 years. All scores (visual analog scale; Short Form-36 subscales, American Orthopaedic Foot & Ankle Society ankle-hindfoot score) showed significant improvement ( < .0001). Mean 1.2 injections were necessary. No significant side effects were seen. However, some mild pain persisted in some patients who participated in sports.
CONCLUSION
The injection of 2.5 mL of 70% ethanol under fluoroscopic and electroneurographic guidance was a safe method for the treatment of MRI-verified Morton's neuromas. Combining the effect of a higher percentage of alcohol and a higher dosage and an improved localization technique resulted in a high rate of patients without pain.
LEVEL OF EVIDENCE
Level IV, cases series, prospective.
Topics: Adult; Aged; Ethanol; Female; Fluoroscopy; Humans; Injections, Intralesional; Male; Middle Aged; Morton Neuroma; Prospective Studies
PubMed: 32013586
DOI: 10.1177/1071100720903096 -
Cureus Jun 2020We report a case of a 55-year-old female with extreme right fourth toe pain of unknown origin that was resistant to conservative care. Resection confirmed invasion of...
We report a case of a 55-year-old female with extreme right fourth toe pain of unknown origin that was resistant to conservative care. Resection confirmed invasion of the neuroma into the fourth digit with hypertrophy and herniation of the proper digital nerve. The patient experienced an uneventful recovery with some minor neurogenic symptoms experienced at six months postoperatively that resolved with off-loading padding and heat massage. Complete pain relief was reported at her 12-month review. Isolated neuroma within a toe results in digital pain that may respond to excision.
PubMed: 32760621
DOI: 10.7759/cureus.8920 -
Radiology Mar 2003To assess the effect of prone, supine, and upright weight-bearing body positions on visibility, position, shape, and size of Morton neuroma during magnetic resonance...
PURPOSE
To assess the effect of prone, supine, and upright weight-bearing body positions on visibility, position, shape, and size of Morton neuroma during magnetic resonance (MR) imaging.
MATERIALS AND METHODS
Eighteen patients with 20 Morton neuromas underwent MR imaging of the forefoot in prone (plantar flexion of the foot), supine (dorsiflexion of the foot), and upright weight-bearing positions. Visibility (3 = good, 2 = moderate, 1 = poor), position relative to the metatarsal bone, shape, and transverse diameter of Morton neuroma were assessed on transverse T1-weighted MR images. Associations between different body positions and variables of interest were calculated with Wilcoxon signed rank test, chi2 test, and paired Student t test.
RESULTS
In the prone position, visibility of all 20 Morton neuromas was rated with a score of 3; visibility in the supine and weight-bearing positions was inferior (mean score, 2.4). All 20 (100%) Morton neuromas changed their position relative to the metatarsal bone between prone and supine and between prone and weight-bearing positions. When compared with the prone position, there was a difference in the shape of all 20 Morton neuromas in the weight-bearing position (P <.001). Between prone (mean transverse diameter of Morton neuroma, 8 mm) and supine (mean transverse diameter of Morton neuroma, 6 mm) positions, the transverse diameter of Morton neuroma significantly decreased by 2 mm (P =.03); between prone and weight-bearing positions, the decrease of the mean transverse diameter was also significant (difference, 2 mm; P =.03).
CONCLUSION
Morton neuroma appears significantly different during MR imaging in prone, supine, or weight-bearing positions. The transverse diameter of Morton neuroma is significantly larger on images obtained in the prone position than it is on images obtained in the supine and upright weight-bearing positions. Visibility of Morton neuroma is best on MR images obtained in the prone position.
Topics: Adult; Aged; Chi-Square Distribution; Female; Foot Diseases; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuroma; Prone Position; Statistics, Nonparametric; Supine Position; Weight-Bearing
PubMed: 12601213
DOI: 10.1148/radiol.2263011925