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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 -
La Radiologia Medica Jul 2021No prior studies investigated the role of ultrasound in the assessment of response of patients undergoing treatment of metatarsalgia with custom-made orthoses. Our aim...
PURPOSE
No prior studies investigated the role of ultrasound in the assessment of response of patients undergoing treatment of metatarsalgia with custom-made orthoses. Our aim was to describe ultrasound findings of patients with plantar forefoot pain treated with custom-made foot orthoses.
METHODS
Twenty patients (15 females; mean age: 62.6 ± 11 years) affected by metatarsalgia in 27/40 feet underwent clinical evaluation before, three months and six months after treatment with custom-made full foot insole with a support proximal and an excavation below the painful metatarsals. Ultrasound was performed before and three months after the use of orthoses to examine the presence of intermetatarsal/submetatarsal bursitis, metatarsophalangeal joints effusion, anterior plantar fat pad oedema, flexor tendinitis/tenosynovitis, and Morton's neuroma. Outcome measures were clinical response with Foot Function Index (FFI)/Visual Analogue Scale (VAS) and ultrasound features changes.
RESULTS
Median VAS and FFI before treatment were 8[5-8.5] and 45.85[32.4-59.4], respectively. After 3 and 6 months of insoles use, both median VAS (2.5 [0-5] and 0 [0-2.75], respectively) and median FFI (7.9 [3.95-20] and 0 [0-3.95], respectively) showed a significant reduction in pain and disability (p < .001). Before treatment, ultrasound revealed 22 intermetatarsal bursitis, 16 submetatarsal bursitis, 10 joint effusions, 20 fat pad oedema, 3 flexor tendinitis/tenosynovitis and 3 Morton's neuromas. After 3 months of treatment, a significant decrease of intermetatarsal bursitis (7, p < .001) was observed. No significant changes were observed in any other ultrasound parameters.
CONCLUSION
Ultrasound might be able to detect some imaging features associated with the response of forefoot pain to custom-made foot orthoses, especially intermetatarsal bursitis.
Topics: Adult; Aged; Equipment Design; Female; Follow-Up Studies; Foot Orthoses; Forefoot, Human; Humans; Male; Metatarsalgia; Middle Aged; Retrospective Studies; Ultrasonography
PubMed: 33881714
DOI: 10.1007/s11547-021-01354-8 -
Zeitschrift Fur Rheumatologie Apr 2022The goal was to assess public interest in a wide range of musculoskeletal symptoms and disorders during the coronavirus disease 2019 (COVID-19) pandemic.
OBJECTIVE
The goal was to assess public interest in a wide range of musculoskeletal symptoms and disorders during the coronavirus disease 2019 (COVID-19) pandemic.
METHODS
We searched Google Trends for 118 search queries within the United States. We compared two timeframes of 2020 (March 15-July 4 and July 5-October 31) to similar timeframes over the four prior years (2016-2019).
RESULTS
In the early pandemic, March 15-July 4, a statistically significant decrease in relative search volume of the majority of queries (60%) was detected, with a significant increase in only 2 queries (i.e. myalgia and toe swelling). In the phase July through October, a statistically significant decrease was detected in only 22% of search queries; there was no difference for 60% of search queries between 2020 and 2016-2019 suggesting a return to their prior levels for most of search queries. Interestingly, the search volume of 18% of search queries (i.e. fatigue, joint pain, muscle pain, myalgia, spondylosis, radiculopathy, myelopathy, neck pain, neck strain, lower back strain, sciatica, shoulder pain, frozen shoulder, elbow pain, lateral epicondylitis, wrist pain, carpal tunnel, hand pain, finger pain, trigger finger, and Morton's neuroma) was significantly increased compared with the four prior years.
CONCLUSION
Public interest focused on COVID-19 and sought online information for COVID-19 symptoms in the early pandemic. In the period July through October, there was an upward trend in musculoskeletal symptoms and some colloquial terms/well-known musculoskeletal conditions coupled with a downward trend in general musculoskeletal disorder terms and certain specific diagnoses. This information may help rheumatologists understand public interest in musculoskeletal symptoms and disorders and address the needs of patients to mitigate the negative impact of the pandemic on outcomes.
Topics: COVID-19; Humans; Infodemiology; Musculoskeletal Diseases; Pandemics; Search Engine; United States
PubMed: 33779835
DOI: 10.1007/s00393-021-00989-2 -
The Journal of Clinical and Aesthetic... Sep 2020Corticosteroid injections are an effective treatment for many medical conditions. However, clinicians must be aware of potential side effects of this treatment modality...
Corticosteroid injections are an effective treatment for many medical conditions. However, clinicians must be aware of potential side effects of this treatment modality so that proper patient counseling can take place. Patients with pigmentary alteration after intra-articular or intralesional corticosteroid injections have rarely been reported in literature. We present an adult male patient with linear depigmentation after an intralesional corticosteroid injection for a Morton's neuroma.
PubMed: 33133342
DOI: No ID Found -
Swiss Medical Weekly Sep 2020There is currently no consensus on the ideal approach for the operative treatment of Morton’s neuroma. The distal transverse plantar approach aims at optimal...
BACKGROUND
There is currently no consensus on the ideal approach for the operative treatment of Morton’s neuroma. The distal transverse plantar approach aims at optimal exposure without the scar complications associated with the longitudinal plantar approach. Long-term evaluation based on validated outcome instruments is lacking. The main purpose of this retrospective study was to evaluate the long-term clinical outcome of this approach using validated function and scar evaluation scores.
METHODS
Forty-nine patients operated on at our institution were examined clinically by two independent observers using the Foot and Ankle Ability Measure (FAAM) and the Vancouver Scar Scale (VSS). Patients who underwent neurectomy alone and those who had additional foot surgery were compared.
RESULTS
Assessment at a mean of 7.9 years (range 4–12) postoperatively revealed a mean FAAM score of 84.8 ± 25% and a mean VSS score of 1.57 ± 1.7. Patients who underwent neurectomy alone had higher FAAM scores at follow up. We observed no complication that required an additional procedure.
CONCLUSIONS
The transverse plantar approach results in good objective outcome scores, including scar healing, in the long term. This is our preferred technique because, in our experience, it offers optimal visualisation of the nerve, does not require deep dissection and allows the exposure of two adjacent web spaces of the foot through a single incision.
Topics: Humans; Morton Neuroma; Neuroma; Retrospective Studies
PubMed: 33038261
DOI: 10.4414/smw.2020.20347 -
Clinical Anatomy (New York, N.Y.) Jul 2021Morton's neuroma is an entrapment neuropathy of the third common plantar digital nerve, caused by the deep transverse metatarsal ligament (DTML). Minimally invasive or...
INTRODUCTION
Morton's neuroma is an entrapment neuropathy of the third common plantar digital nerve, caused by the deep transverse metatarsal ligament (DTML). Minimally invasive or percutaneous surgery is a very common procedure, but surgical effectivity of this technique remains controversial. The goal of our study was to prove the effectiveness and safety of a new ultrasound-guided technique for DTML-release in a cadaver model.
MATERIALS, METHODS, AND RESULTS
The DTML was visualized in 10 fresh frozen donated body to science-feet (eight male and two females, five left and five right) using an US device (GE Logic R7; 13 MHz linear probe, Madrid, Spain). Consecutively, minimally invasive ultrasound-guided surgery was performed. Exclusion criteria of the donated bodies to science were previous history of forefoot surgery and space occupying mass lesions. The complete release of the ligament was achieved in all specimens without damage of any important anatomical structures as proven by anatomical dissection.
CONCLUSIONS
The results of this study indicate that our novel approach of an ultrasound-guided release of the DTML is safer and more effective compared to blind techniques. The DTML could reliably be visualized and securely cut through a dorsal, minimally invasive surgical incision of only 2 mm.
Topics: Anatomic Landmarks; Cadaver; Female; Humans; Ligaments, Articular; Male; Metatarsal Bones; Minimally Invasive Surgical Procedures; Ultrasonography, Interventional
PubMed: 33012024
DOI: 10.1002/ca.23692 -
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 -
Journal of Hand and Microsurgery Jul 2022
PubMed: 36016634
DOI: 10.1055/s-0040-1713081 -
Acta Bio-medica : Atenei Parmensis May 2020Civinini Morton's Syndrome (CMS), better known as Morton's Neuroma, is a benign enlargement that typically affects the third common digital branch of the plantar nerve.... (Review)
Review
Civinini Morton's Syndrome (CMS), better known as Morton's Neuroma, is a benign enlargement that typically affects the third common digital branch of the plantar nerve. It is a common cause of metatarsalgia leading to debilitating pain. It prefers the female gender, with a female to male ratio of 5:1 and an average age of 50 years at time of surgery. Precise aetiology remains under debate, with four etiopathogenetic theories often cited in the literature. Clinical symptoms, physical exam and instrumental evidence are important in assessing and grading the disease. Biomechanics seem to play an important role, especially regarding the usefulness of correct footwear. The first approach in the early stages of this condition usually begins with shoe modifications and orthotics, designed to limit the nerve compression. In order to prevent or delay the development of CMS, shoes should be sufficiently long, comfortable, broad toe-boxed, should bear a flat heel and a sufficiently thick external sole which should not be excessively flexible. Most authors suggested that an insole with medial arch support and a retrocapital bar or pad, just proximal to the metatarsal heads, displaces the pressure sites and can be beneficial to relieve the pain from the pinched nerve. A threshold period of 4.5 months appears to emerge from the results of the analysed studies, indicating that, beyond this period and in neuromas larger than 5-6 mm, orthotics and/or shoes modifications do not seem to give convincing results, proving to be more a palliation for the clinical condition to allow an acceptable life with pain rather than a real treatment.
Topics: Conservative Treatment; Equipment Design; Humans; Morton Neuroma; Orthotic Devices; Shoes; Syndrome; Treatment Outcome
PubMed: 32555077
DOI: 10.23750/abm.v91i4-S.9713 -
Journal of Vascular Surgery Cases and... Jun 2020A 65-year-old woman presented to our institution with 4 months of severe pain on the plantar aspect of her foot. She had chronic foot pain secondary to Morton's neuroma...
A 65-year-old woman presented to our institution with 4 months of severe pain on the plantar aspect of her foot. She had chronic foot pain secondary to Morton's neuroma and had recently undergone neurectomy. She was found to have a large pseudoaneurysm on the plantar aspect of her foot. She was taken to the operating room for an open repair from a plantar approach. We obtained the patient's consent to publish this case.
PubMed: 32490299
DOI: 10.1016/j.jvscit.2020.03.007