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Radiology May 1989One hundred consecutive patients with symptoms suggestive of Morton neuroma were examined with sonography, and 134 intermetatarsal masses were demonstrated. Forty-five...
One hundred consecutive patients with symptoms suggestive of Morton neuroma were examined with sonography, and 134 intermetatarsal masses were demonstrated. Forty-five patients underwent surgical exploration, which revealed Morton neuromas. The typical sonographic appearance is that of an ovoid, hypoechoic mass oriented parallel to the long axis of the metatarsals. Most masses were between the second and third or third and fourth metatarsals and seemed to produce symptoms when reaching a diameter of 5 mm.
Topics: Adult; Aged; Female; Foot Diseases; Humans; Male; Middle Aged; Neuroma; Soft Tissue Neoplasms; Toes; Ultrasonography
PubMed: 2649918
DOI: 10.1148/radiology.171.2.2649918 -
AJR. American Journal of Roentgenology Feb 2022. Morton neuroma is a common, painful disorder of the foot with multiple treatment options of varying cost and effectiveness. . The aim of this study was to determine... (Comparative Study)
Comparative Study
. Morton neuroma is a common, painful disorder of the foot with multiple treatment options of varying cost and effectiveness. . The aim of this study was to determine the most cost-effective treatment pathway for symptomatic Morton neuromas when conservative management has failed. . An incremental cost-utility analysis was performed comparing a direct to surgical neurectomy strategy with three selective injection strategies in which one or more ultrasound-guided injection therapies was tried first before surgery for patients who did not respond to treatment. The three selective injection strategies were selective steroid injection, selective alcohol injection, and selective steroid/alcohol injection in which both steroid injections and alcohol sclerosing injections were trialed successively before surgical neurectomy. The direct-to-surgery approach was compared with the three different selective injection strategies and with a no-treatment strategy in a decision-analytic model for a hypothetical group of patients with symptomatic Morton neuroma in whom conservative management had failed. Model parameters, including treatment costs, effectiveness, complication rates, and health utility states, were estimated from the literature, reimbursement databases, and expert opinion. The outcome was cost per quality-adjusted life year (QALY) with a time horizon of 3 years. A societal cost perspective was adopted with a willingness-to-pay threshold of $100,000/QALY. Sensitivity analyses for key model parameters were performed. . For the base input values, the steroid/alcohol selective injection strategy was dominant and yielded an incremental cost-effectiveness ratio of $4401.61/QALY compared with no treatment. The probabilistic sensitivity analysis supported this strategy in 74% of 10,000 simulated trials. Results were robust with low sensitivity to most input parameters. However, when the probability of successful alcohol injection treatment dropped below 40%, the steroid selective injection strategy became most cost-effective. . A trial of ultrasound-guided injection therapies for Morton neuroma is a cost-effective strategy compared with proceeding directly to surgical neurectomy. . Ultrasound-guided injection therapies are indicated as first-line treatment of patients with symptomatic Morton neuromas when conservative management fails.
Topics: Adrenal Cortex Hormones; Cost-Benefit Analysis; Denervation; Ethanol; Health Care Costs; Humans; Morton Neuroma; Treatment Outcome; Ultrasonography, Interventional
PubMed: 34523955
DOI: 10.2214/AJR.21.26419 -
Heliyon Aug 2023Morton's neuroma (MN) is a compressive neuropathy of the common digital plantar nerve causing forefoot pain. Foot posture and altered plantar pressure distribution have...
Morton's neuroma (MN) is a compressive neuropathy of the common digital plantar nerve causing forefoot pain. Foot posture and altered plantar pressure distribution have been identified as predispoing factors, however no studies have compared individuls with different foot postures with MN. Thus, we aimed to compare the effect of MN on spatiotemporal gait parameters and foot-pressure distribution in individuals with pes planus and pes cavus. Thirty-eight patients with unilateral MN were evaluated between June and August 2021. Nineteen patients with bilateral pes planus and 19 age and gender-matched patients with pes cavus who had no prior surgery were recruited. A Zebris FDM-THM-S treadmill system (Zebris Medical GmbH, Germany) was used to evaluate step length, stride length, step width, step time, stride time, cadence, velocity, foot-pressure distribution, force and whole stance phase, loading response, mid stance, pre-swing and swing phase percentages. There were no significant differences between the groups in spatiotemporal gait parameters (p > 0.05). Patients with pes planus displayed the following results for step length (49.36 ± 8.38), step width (9.05 ± 2.12), stance phase percentage (65.92 ± 2.11), swing phase percentage (34.08 ± 2.12), gait speed (2.96 ± 0.55), and cadence (100.57 ± 8.84). In contrast, patients with pes cavus displayed the following results for step length (49.06 ± 8.37), step width (8.10 ± 2.46), stance phase percentage (64.96 ± 1.61), swing phase percentage (34.79 ± 1.60), gait speed (2.95 ± 0.65), and cadence (99.73 ± 13.81). Foot-pressure distribution values showed no differences were detected in force, forefoot, and rearfoot pressure distribution, except for midfoot force (p < 0.05). The forefoot, midfoot, and rearfoot pressure values for the pronated group were 32.14 ± 10.90, 13.80 ± 3.03, and 22.78 ± 5.10, and for the supinated group were 33.50 ± 11.49, 14.23 ± 3.11 and 24.93 ± 6.52. MN does not significantly affect spatiotemporal gait parameters or foot-pressure distribution in patients with pes cavus or pes planus.
PubMed: 37636349
DOI: 10.1016/j.heliyon.2023.e19111 -
Foot (Edinburgh, Scotland) Jun 2021"Morton's Neuroma" is a frequent cause of chronic forefoot pain. It can affect general population, including athletes, and can lead to progressive foot pain and...
BACKGROUND
"Morton's Neuroma" is a frequent cause of chronic forefoot pain. It can affect general population, including athletes, and can lead to progressive foot pain and discomfort for daily life activities and sports.
HYPOTHESIS/PURPOSE
Our objective is to evaluate the long-term results in a series of 85 feet, operatively treated with minimally invasive interdigital approach for neurectomy.
STUDY DESIGN
Case series.
METHOD
83 patients (85 feet) were treated between January 2003 and December 2019. The AOFAS score and VAS scale were used to evaluate the patients pre and postoperatively. Results were analyzed using the JASP software.
RESULTS
Mean age was 50.58 years (range 23-77). Eleven (11) were men, and seventy-four (74) women, with two bilateral cases. Mean follow up was 49 months. Our series was evaluated with AOFAS and VAS scores, both showing statistically significant improvement posterior to the operative procedure.
CONCLUSIONS
A series of 85 feet operatively treated for Morton's neuroma with minimally invasive interdigital approach for neurectomy is presented. Long term results were similar to other published series with different approaches, with the advantage of minimal incision, minimum soft tissue dissection and no need to release intermetatarsal ligament, immediate weightbearing and quick return to daily activities and sports. It is concluded that minimally invasive neurectomy with interdigital approach is a safe procedure for Morton's neuroma treatment with similar results that other operative procedures.
LEVEL EVIDENCE
Level IV.
Topics: Adult; Aged; Denervation; Female; Foot Diseases; Humans; Male; Middle Aged; Morton Neuroma; Neuroma; Pain Measurement; Retrospective Studies; Young Adult
PubMed: 33945999
DOI: 10.1016/j.foot.2021.101808 -
Journal of the American Podiatric... Nov 1992
Topics: Chicago; Foot Diseases; History, 20th Century; Humans; Neuroma
PubMed: 1460580
DOI: 10.7547/87507315-82-11-594 -
Australian Family Physician Aug 1987
Topics: Foot Diseases; Humans; Neuroma; Pain
PubMed: 3675347
DOI: No ID Found -
Orthopedic Nursing 1982
Topics: Foot Diseases; Humans; Neuroma; Postoperative Care
PubMed: 6917335
DOI: No ID Found -
Journal of the Medical Association of... May 1973
Topics: Adolescent; Adult; Child; Child, Preschool; Female; Foot Diseases; Humans; Infant; Male; Neuralgia; Toe Joint
PubMed: 4714088
DOI: No ID Found -
Foot and Ankle Surgery : Official... Jun 2024Current literature lacks comprehensive information comparing the clinical outcomes of plantar and dorsal approaches for Civinini-Morton syndrome, also known as Morton's... (Review)
Review
BACKGROUND
Current literature lacks comprehensive information comparing the clinical outcomes of plantar and dorsal approaches for Civinini-Morton syndrome, also known as Morton's neuroma. This systematic review and meta-analysis was conducted to evaluate and compare the clinical outcomes of neurectomy for Morton's neuroma, focusing on the differences between the plantar and dorsal approach.
METHODS
Our comprehensive literature review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and utilized databases including PubMed, Embase, Web of Science, and the Cochrane Library. Data investigated in this study included postoperative sensory loss, scar tenderness, reoperation, histopathology, complications, pain score, patient satisfaction, functional scores, and time to weight bearing.
RESULTS
Total eight studies were included in this study. In aggregate, 237 neuromas underwent excision using the plantar approach, while 312 neuromas were treated via the dorsal approach. A significantly higher rate of postoperative reduced sensory was found in the dorsal group: 48.5 % (64/132) Vs. 62.0 % (80/129) with the relative ratio (RR) of 0.79 (95 % CI, 0.64-0.97). A significantly higher rate of postoperative scar tenderness was noted in the plantar group: 16.7 % (32/192) Vs. 6.2 % (14/225) with the RR of 2.27 (95 % CI, 1.28-4.04). Regarding the histopathology, 99.3 % (143/144) and 97.1 % (134/138) accuracy rate was confirmed in the plantar approach and dorsal approach, respectively, with the RR of 1.02 (95 % CI, 0.98-1.07). Overall reoperations and complications were not different between groups at 5.3 % (10/189) and 8.8 % (19/216) in the plantar group versus 6.1 % and 12.0 % (35/291) in dorsal group.
CONCLUSIONS
We recommend detailed discussions with patients prior to surgery to weigh the advantages and disadvantages of each approach.
PubMed: 38880729
DOI: 10.1016/j.fas.2024.05.018 -
European Radiology Dec 2022This work compares the effectiveness of blind versus ultrasound (US)-guided injections for Morton neuroma (MN) up to 3 years of follow-up. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
This work compares the effectiveness of blind versus ultrasound (US)-guided injections for Morton neuroma (MN) up to 3 years of follow-up.
METHODS
This is an evaluator-blinded randomised trial in which 33 patients with MN were injected by an experienced orthopaedic surgeon based on anatomical landmarks (blind injection, group 1) and 38 patients were injected by an experienced musculoskeletal radiologist under US guidance (group 2). Patients were assessed using the visual analogue scale and the Manchester Foot Pain and Disability index (MFPDI). Injections consisted of 1 ml of 2% mepivacaine and 40 mg triamcinolone acetonide in each web space with MN. Up to 4 injections were allowed during the first 3 months of follow-up. Follow-up was performed by phone calls and/or scheduled consultations at 15 days, 1 month, 45 days, 2 months, 3 months, 6 months and 1, 2 and 3 years. Statistical analysis was performed using unpaired Student's t tests.
RESULTS
No differences in age or clinical measures were found at presentation between group 1 (VAS, 8.5 ± 0.2; MFPDI, 40.9 ± 1.1) and group 2 (VAS, 8.4 ± 0.2; MFPDI, 39.8 ± 1.2). Improvement in VAS was superior in group 2 up to 3 years of follow-up (p < 0.05). Improvement in MFPDI was superior in group 2 from 45 days to 2 years of follow-up (p < 0.05). Satisfaction with the treatment was higher in group 2 (87%) versus group 1 (59.1%) at 3 years of follow-up.
CONCLUSION
Ultrasound-guided injections lead to a greater percentage of long-term improvement than blind injections in MN.
KEY POINTS
• Ultrasound-guided corticosteroid injections in Morton neuroma provide long-term pain relief in more than 75% of patients. • Ultrasound-guided injections in Morton neuroma led to greater long-term pain relief and less disability than blind injections up to 3 years of follow-up. • The presence of an ipsilateral neuroma is associated with worse long-term disability score.
Topics: Humans; Morton Neuroma; Mepivacaine; Adrenal Cortex Hormones; Neuroma; Pain; Ultrasonography, Interventional; Treatment Outcome
PubMed: 35726101
DOI: 10.1007/s00330-022-08932-y