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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 -
The Bone & Joint Journal Mar 2017Morton's neuroma is common condition of the forefoot, but its aetiology remains unclear. Our aim was to evaluate the relationship between the width of the forefoot and...
AIMS
Morton's neuroma is common condition of the forefoot, but its aetiology remains unclear. Our aim was to evaluate the relationship between the width of the forefoot and the development of a Morton's neuroma.
PATIENTS AND METHODS
Between January 2013 and May 2016, a total of 84 consecutive patients (17 men, 67 women) with a unilateral Morton's neuroma were enrolled into the study. The involved and uninvolved feet of each patient were compared. A control group of patients with symptoms from the foot, but without a neuroma who were matched for age, gender, affected side, and web space location, were enrolled. The first to fifth intermetatarsal distance, intermetatarsal angle and intermetatarsal distance of involved web space on standing radiographs were assessed.
RESULTS
The inter- and intra-observer reliability was excellent. The three parameters did not differ significantly between the involved and uninvolved feet. Neither did they differ significantly between the patients and the controls.
CONCLUSION
We conclude that there is no significant relationship between the width of the forefoot and the development of a Morton's neuroma. Cite this article: 2017;99-B:365-8.
Topics: Adult; Aged; Anthropometry; Case-Control Studies; Female; Forefoot, Human; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Morton Neuroma; Observer Variation; Radiography; Ultrasonography; Young Adult
PubMed: 28249977
DOI: 10.1302/0301-620X.99B3.BJJ-2016-0661.R1 -
Skeletal Radiology Mar 2022To assess the value of the divergence of toes on conventional radiographs of the foot for diagnosing Morton's neuroma.
OBJECTIVES
To assess the value of the divergence of toes on conventional radiographs of the foot for diagnosing Morton's neuroma.
METHODS
This retrospective case-control study was approved by the local ethics committee. In 100 patients with MRI-proven Morton's neuroma 2/3 or 3/4 (study group) and 100 patients without (control group), conventional weight-bearing dorso-plantar view radiographs were evaluated for the subjective presence of interphalangeal divergence, called the Vulcan salute sign or V-sign, by two blinded, independent musculoskeletal radiologists. Interphalangeal angles (2/3 and 3/4) and intermetatarsal angle I/V were measured. The t test and chi-squared test were used to compare the groups. Diagnostic performance was calculated. Interobserver reliability was assessed using κ statistics and intraclass correlation coefficient (ICC).
RESULTS
The difference between the groups was significant (P < 0.05) regarding the presence of the V-sign, which was found in 30 of 100 patients with Morton neuroma and in 3 of 100 control patients, with a sensitivity of 30% and a specificity of 97%. The differences between interphalangeal angles were significant (P < 0.05) between the groups. The interphalangeal angle 2/3 mean values were 7.9° (± 4.8) for the study group vs 5.4° (± 2.6) for the controls; the 3/4 angle values were 6.5° (± 3.8) and 3.4° (± 2.5), respectively. There was no significant difference between the groups in the intermetatarsal angle I/V. Interobserver agreement was substantial for the V-sign, with a κ value of 0.78. The ICC was excellent concerning angle measurements, with all values ≥ 0.94.
CONCLUSION
The Vulcan salute sign on conventional radiographs is specific for Morton's neuroma.
Topics: Case-Control Studies; Humans; Morton Neuroma; Neuroma; Radiography; Reproducibility of Results; Retrospective Studies
PubMed: 34263343
DOI: 10.1007/s00256-021-03851-3 -
The Bone & Joint Journal Oct 2016This is the first prospective study to report the pre- and post-operative patient reported outcomes and satisfaction scores following excision of interdigital Morton's...
AIMS
This is the first prospective study to report the pre- and post-operative patient reported outcomes and satisfaction scores following excision of interdigital Morton's neuroma.
PATIENTS AND METHODS
Between May 2006 and April 2013, we prospectively studied 99 consecutive patients (111 feet) who were to undergo excision of a Morton's neuroma. There were 78 women and 21 men with a mean age at the time of surgery of 56 years (22 to 78). Patients completed the Manchester-Oxford Foot Questionnaire (MOXFQ), Short Form-12 (SF-12) and a supplementary patient satisfaction survey three months pre-operatively and six months post-operatively.
RESULTS
Statistically significant differences were found between the mean pre- and post-operative MOXFQ and the physical component of the SF-12 scores (p = 0.00081 and p = 0.00092 respectively). Most patients reported their overall satisfaction as excellent (n = 49, 49.5%) or good (n = 29, 29.3%), but ten patients were dissatisfied, reporting poor (n = 8, 8.1%) or very poor (n = 2, 2.0%) results. Only 63 patients (63%) were pain-free at follow-up: in eight patients (8.1%), the MOXFQ score worsened. There was no statistically significant difference in outcome between surgery on single or multiple sites. However, the MOXFQ scores were significantly worse after revision surgery (p = 0.004).
CONCLUSIONS
The patient-reported outcomes after resection of a symptomatic Morton's neuroma are acceptable but may not be as good as earlier studies suggest. Surgery at several sites can be undertaken safely but caution should be exercised when considering revision surgery. Cite this article: Bone Joint J 2016;98-B:1376-81.
Topics: Adult; Aged; Female; Follow-Up Studies; Foot; Humans; Male; Middle Aged; Morton Neuroma; Orthopedic Procedures; Patient Satisfaction; Postoperative Period; Prospective Studies; Range of Motion, Articular; Surveys and Questionnaires; Treatment Outcome; Young Adult
PubMed: 27694592
DOI: 10.1302/0301-620X.98B10.37610 -
Forefoot Pain in the Lesser Toes: Anatomical Considerations and Magnetic Resonance Imaging Findings.Canadian Association of Radiologists... Nov 2019Various conditions may result in forefoot pain. Magnetic resonance (MR) imaging allows accurate assessment of many of these conditions. We provide an overview of... (Review)
Review
Various conditions may result in forefoot pain. Magnetic resonance (MR) imaging allows accurate assessment of many of these conditions. We provide an overview of forefoot disorders divided into bones, capsule and plantar plate, musculotendinous structures, neurovascular structures, and subcutaneous tissue. We review normal anatomical features as well as MR imaging findings of common disorders.
Topics: Humans; Magnetic Resonance Imaging; Metatarsalgia; Toes
PubMed: 31685098
DOI: 10.1016/j.carj.2019.06.010 -
Journal of Hand Surgery Global Online Jan 2023Painful neuromas commonly cause neuropathic pain, in up to 1 in 20 cases of traumatic or iatrogenic nerve injury. Despite the multiple surgical treatment types that...
PURPOSE
Painful neuromas commonly cause neuropathic pain, in up to 1 in 20 cases of traumatic or iatrogenic nerve injury. Despite the multiple surgical treatment types that reduce pain, no type has been universally accepted.
METHODS
We performed a retrospective cohort study by administering follow-up surveys to all surgical patients treated in our department for lower-extremity neuroma from September 1, 2015, to October 22, 2021, that could be contacted, excluding those with Morton neuroma. In addition to the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) questionnaire, survey questions covered the time to pain reduction, use of physical or occupational therapy, and characteristics of the pain. When available, previously collected preoperative and postoperative PROMIS PI data were used for patients who could not be contacted for the telephone survey. Paired-sample nonparametric testing was used to compare preoperative and postoperative PROMIS PI scores.
RESULTS
Initial query in the medical record by Current Procedural Terminology codes yielded 1,812 patients for chart review, of whom 33 were eligible to call. In total, 9 (27%) patients completed both preoperative and postoperative PROMIS PIs: 6 (18.2%) completed full telephone surveys and 3 (9.1%) had preoperative and postoperative PROMIS PI data in the chart review but could not be contacted for the full telephone survey. Four of the 6 telephone-survey respondents reported pain reduction within 12 months of their surgery. Wilcoxon signed-rank testing demonstrated a moderate but nonstatistically significant reduction in PROMIS PI scores, with a median difference of -4.85 ( = .1; 95% CI -12 to 1.2).
CONCLUSIONS
There were notable improvements in our cohort, but larger studies are needed to determine whether surgical treatment of lower-extremity neuroma results in a clinically important and significant difference in PROMIS PI scores, as well as to discern the advantages each treatment.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
PubMed: 36704377
DOI: 10.1016/j.jhsg.2022.03.005 -
Clinical Drug Investigation Jul 2013Morton neuroma is a common cause of metatarsalgia of neuropathic origin. Systematic reviews suggest that insufficient studies have been performed on the efficacy of the...
BACKGROUND AND OBJECTIVE
Morton neuroma is a common cause of metatarsalgia of neuropathic origin. Systematic reviews suggest that insufficient studies have been performed on the efficacy of the different treatments available. OnabotulinumtoxinA has shown a degree of usefulness in other conditions associated with neuropathic pain. The aim of this study was to investigate the therapeutic potential of onabotulinumtoxinA in Morton neuroma.
PATIENTS AND METHODS
We present an open-label, pilot study with 17 consecutive patients with Morton neuroma and pain of more than 3 months' duration that had not responded to conservative treatment with physical measures or corticosteroid injection. Patients received one onabotulinumtoxinA injection in the area of the neuroma. The main outcome measure was the variation in the pain on walking evaluated using a visual analogue scale (VAS) before treatment and at 1 and 3 months after treatment. The secondary outcome was the change in foot function, which was assessed using the Foot Health Status Questionnaire.
RESULTS
In the overall group, the mean initial VAS score on walking was 7. This mean score had fallen to 4.8 at 1 month after treatment and to 3.7 at 3 months. Twelve patients (70.6 %) reported an improvement in their pain and five patients (29.4 %) reported no change; exacerbation of the pain did not occur in any patient. Improvements were also observed in two of the dimensions of the Foot Health Status Questionnaire: foot pain, which improved from a mean of 38.88 before treatment to 57 at 3 months, and foot function, which improved from a mean of 42.27 before treatment to 59.9 at 3 months. Clinical variables including age, sex, site and size of the lesion, standing activity, weekly duration of walking, footwear, foot type and footprint had no influence on the outcome. No adverse effects were reported.
CONCLUSIONS
In this pilot study, injection with onabotulinumtoxinA was shown to be of possible usefulness to relieve the pain and improve function in Morton neuroma. This finding opens the door to further clinical research.
Topics: Botulinum Toxins, Type A; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuroma; Pilot Projects
PubMed: 23740337
DOI: 10.1007/s40261-013-0090-0 -
EFORT Open Reviews Dec 2021Tarsal tunnel syndrome (TTS) is a neuropathy due to compression of the posterior tibial nerve and its branches. It is usually underdiagnosed and its aetiology is very...
Tarsal tunnel syndrome (TTS) is a neuropathy due to compression of the posterior tibial nerve and its branches. It is usually underdiagnosed and its aetiology is very diverse. In 20% of cases it is idiopathic. There is no test that diagnoses it with certainty. The diagnosis is usually made by correlating clinical history, imaging tests, nerve conduction studies (NCSs) and electromyography (EMG). A differential diagnosis should be made with plantar fasciitis, lumbosacral radiculopathy (especially S1 radiculopathy), rheumatologic diseases, metatarsal stress fractures and Morton's neuroma. Conservative management usually gives good results. It includes activity modification, administration of pain relief drugs, physical and rehabilitation medicine, and corticosteroid injections into the tarsal tunnel (to reduce oedema). Abnormally slow nerve conduction through the posterior tibial nerve usually predicts failure of conservative treatment. Indications for surgical treatment are failure of conservative treatment and clear identification of the cause of the entrapment. In these circumstances, the results are usually satisfactory. Surgical success rates vary from 44% to 96%. Surgical treatment involves releasing the flexor retinaculum from its proximal attachment near the medial malleolus down to the sustentaculum tali. Ultrasound-guided tarsal tunnel release is possible. A positive Tinel's sign before surgery is a strong predictor of surgical relief after decompression. Surgical treatment achieves the best results in young patients, those with a clear aetiology, a positive Tinel's sign prior to surgery, a short history of symptoms, an early diagnosis and no previous ankle pathology.
PubMed: 35839088
DOI: 10.1302/2058-5241.6.210031 -
International Wound Journal Aug 2013Morton's neuroma is an entrapment neuropathy of the plantar digital nerve. We treated five patients with wound dehiscence and tendon exposure, after Morton's neuroma...
Morton's neuroma is an entrapment neuropathy of the plantar digital nerve. We treated five patients with wound dehiscence and tendon exposure, after Morton's neuroma surgery excision using a dorsal approach. In this article we describe our technique. From July 2010 to August 2011, at the Department of Plastic and Reconstructive Surgery, University of Rome 'Tor Vergata', five patients (four females and one male), with ages ranging between 35 and 52 years, were treated with a combination of PRP (platelet rich plasma) and HA (hyaluronic acid). Thirty days following surgery, all patients showed a complete healing of the wound. The use of this technique for the treatment of postoperative wound dehiscence and tendon exposure has proven as satisfactory.
Topics: Adult; Cohort Studies; Decompression, Surgical; Female; Follow-Up Studies; Foot Diseases; Humans; Hyaluronic Acid; Injections, Intralesional; Italy; Male; Middle Aged; Nerve Compression Syndromes; Neuroma; Platelet-Rich Plasma; Postoperative Care; Prospective Studies; Plastic Surgery Procedures; Reoperation; Surgical Wound Dehiscence; Treatment Outcome; Wound Healing
PubMed: 22694086
DOI: 10.1111/j.1742-481X.2012.00992.x -
International Orthopaedics Sep 2013Long-term results following surgical treatment of Morton neuroma are rare. The purpose of the present study was to evaluate patients after excision of Morton's neuroma...
PURPOSE
Long-term results following surgical treatment of Morton neuroma are rare. The purpose of the present study was to evaluate patients after excision of Morton's neuroma at least ten years following surgery.
METHODS
We performed a retrospective review of the patients' records who underwent excision of an interdigital neuroma with the clinical diagnosis of Morton's neuroma. Eighty-one patients who had undergone surgery on 98 feet were analysed at an average of 15.3 years postoperatively. In total 111 neuromas were excised, because in 13 feet more than one neuroma was identified clinically. Follow-up evaluation included physical examination and a radiographic evaluation. The interdigital neuroma clinical evaluation score and the AOFAS score were assessed.
RESULTS
An excellent result was reported for 44 feet (44.9 %), a good result for 31 feet (31.6 %) and a fair one for 15 feet (15,3 %). Eight feet had a poor result (8.2 %), in all of them an amputation neuroma was diagnosed. The average neuroma score was 62 points (range 20-80) and the AOFAS score 75 points (range 29-100). Sixty-one feet (62.2 %) had concomitant foot and ankle disorders not related to the primary diagnosis of Morton's neuroma. Numbness was assessed in 72 % (72 feet), a normal sensibility in 26 % (26 feet) and dyaesthesia in 1 % (one foot). The clinical outcome was not influenced by existence of sensory deficits (p = 0.646); analysis of location of neuroma showed best results for those in the third webspace. A significantly worse outcome was found in patients operated on multiple neuromas compared to single neuroma (p = 0.038).
CONCLUSION
Surgical excision of a Morton's neuroma results in good clinical results and high overall patient's satisfaction in the long term. Multiple neuromas have worse outcome than single neuromas. Sensory deficits and concomitant foot and ankles disorders are common, but do not have an influence on patient's satisfaction.
Topics: Adult; Aged; Female; Follow-Up Studies; Foot Diseases; Humans; Male; Middle Aged; Neuroma; Patient Satisfaction; Retrospective Studies; Toes; Treatment Outcome; Young Adult
PubMed: 23851648
DOI: 10.1007/s00264-013-2002-6