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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 -
International Orthopaedics Apr 2010Morton's neuroma is a common cause of metatarsalgia caused by intermetarsal digital nerve thickening. This study reviews the pathology, presentation, symptoms and signs,...
Morton's neuroma is a common cause of metatarsalgia caused by intermetarsal digital nerve thickening. This study reviews the pathology, presentation, symptoms and signs, and patient satisfaction with surgical treatment. Seventy-eight patients (82 feet) were treated for Morton's metatarsalgia by excision of the interdigital nerve. The patients were followed-up for a mean of 4.6 years (range 0.8-8.1 years) and scored using the Foot Functional Index and the American Orthopedic Foot Ankle Society scoring system. In 74 patients the Foot Functional Index was more than 85 (maximum score 100). Seventy-one patients scored more than 90 on the American Orthopedic Foot Ankle Society scoring system with two patients scoring 100 (maximum score). Postoperatively, 82% reported excellent or good results, 10% had a fair result with restriction of activities or pain and 8% had no improvement at all after surgery while 71% had restrictions with footwear.
Topics: Activities of Daily Living; Adult; Aged; Female; Humans; Male; Metatarsophalangeal Joint; Middle Aged; Neuralgia; Neuroma; Peripheral Nerves; Peripheral Nervous System Neoplasms; Recovery of Function; Treatment Outcome; Young Adult
PubMed: 19484237
DOI: 10.1007/s00264-009-0812-3 -
Acta Bio-medica : Atenei Parmensis Jan 2019Schwannoma is a soft tissue tumor that rarely presents in the foot. Patients are usually asymptomatic, but in some cases symptoms typically result from the mass effect... (Review)
Review
Schwannoma is a soft tissue tumor that rarely presents in the foot. Patients are usually asymptomatic, but in some cases symptoms typically result from the mass effect and direct involvement of the nerve and surrounding tissue. We report on four consecutive cases. The first patient was a 57-years-old female that referred symptoms similar to the Morton's neuroma with a mass arising from the medial plantar nerve. The second patient was treated for a schwannoma in the plantar area. The third case was a female with a schwannoma arising from the sural nerve and the fourth patient had a tumor arising from the medial plantar nerve. All patients underwent surgical excision and histological evaluation. No signs of neurological deficit or recurrence were observed at final follow-up. Purpose of the study was to define clinical features, optimal management and outcome of schwannomas of the foot, through an accurate review of the literature.
Topics: Female; Foot; Humans; Male; Middle Aged; Neurilemmoma; Soft Tissue Neoplasms
PubMed: 30715028
DOI: 10.23750/abm.v90i1-S.8079 -
Journal of Clinical Medicine Jul 2023Morton's neuroma (MN) is a compressive neuropathy of the common plantar digital nerve, most commonly affecting the third inter-digital space. The conservative approach...
Morton's neuroma (MN) is a compressive neuropathy of the common plantar digital nerve, most commonly affecting the third inter-digital space. The conservative approach is the first recommended treatment option. However, other different approaches have been proposed, offering several options of treatments, where, several degrees of efficacy and safety have been reported. We treated five consecutive patients affected by MN through three indirect ultrasound-guided injections of type I porcine collagen at weekly intervals. All patients were assessed before the treatment, after the treatment and up to 6 months after the last injection via AOFAS and VNS scores for pain, in which the function and pain were evaluated, respectively. In all patients, both analyzed variables progressively ameliorated, with benefits lasting until the last follow-up. The trend of the scores during the follow-up showed significant statistical differences. No side effects occurred. To our knowledge, this is the first study on injections of type I porcine collagen for the treatment of Morton's neuroma. Future research is needed to confirm the positive trend achieved in this MN mini-series.
PubMed: 37510755
DOI: 10.3390/jcm12144640 -
Journal of Clinical Medicine May 2022Insufficient space below the Deep Transverse Metatarsal Ligament (DTML) could be an etiological factor for Morton’s Neuroma (MN). To date, there is a lack of studies...
Insufficient space below the Deep Transverse Metatarsal Ligament (DTML) could be an etiological factor for Morton’s Neuroma (MN). To date, there is a lack of studies measuring the space below the DTML. For this reason, this study assesses the intra- and inter-rater concordance and reproducibility of measurements of the space below the DTML between the third and the fourth metatarsal heads (M3 and M4) using ultrasound imaging to assess and verify the reliability and reproducibility of measurements of the space under the DTML. Forty feet from twenty patients were examined using ultrasound by three trained evaluators at two different times. The two measurements taken on each foot were: base (b)—distance between M3 and M4, and height (h)—distance between the DTML and the plantar skin surface. This was a quantitative, observational, analytical study. The concordance rate between observers for measurements of height and base were 98.5% and 99.5%, respectively. The mean area obtained of the space was 54.6 mm2 and 57.2 mm2 for both the left and right foot (p > 0.05). Reproducibility over time calculated in pre- and post-measurements showed an intraclass correlation coefficient of 1.00 (95%CI: 0.99−1.00), which leads us to conclude that the measurements are perfectly reproducible. Both measurements (height and base) of the space under the DTML, performed by ultrasound, are reliable and reproducible.
PubMed: 35566678
DOI: 10.3390/jcm11092553 -
Canadian Journal of Surgery. Journal... Apr 1998To determine the outcome of surgical excision of Morton's neuroma after a local anesthetic diagnostic block into the neuroma has relieved symptoms.
OBJECTIVE
To determine the outcome of surgical excision of Morton's neuroma after a local anesthetic diagnostic block into the neuroma has relieved symptoms.
DESIGN
A cohort study.
SETTING
A university affiliated hospital.
PATIENTS
A sequential series of 37 patients who underwent 41 excisions with at least 2 years' follow-up. Seven patients had undergone repeat excision of a neuroma, and 34 primary excisions were performed. Surgery was performed by a specialist in orthopedic surgery of the foot and ankle.
INTERVENTION
Excision of the Morton's neuroma after a positive diagnostic block.
MAIN OUTCOME MEASURES
Grade of symptoms at follow-up done by independent review on a 4-point scale.
RESULTS
Of 41 procedures, 11 had an unfavourable outcome: 4 procedures were graded 3, and 7 procedures were graded 4. Eight (24%) of the 34 primary procedures were reported as failures, and 3 (43%) of the 7 revision procedures were reported as failures. Most patients reported poor results owing to persistent pain.
CONCLUSIONS
Diagnostic blocks do not improve the results of surgery for excision of Morton's neuroma and are not recommended. Because failure rates are greater than 20%, surgery for Morton's neuroma should only be offered after a full course of nonoperative management.
Topics: Adult; Aged; Anesthetics, Local; Female; Follow-Up Studies; Foot Diseases; Humans; Male; Middle Aged; Neuroma; Orthotic Devices; Pain; Postoperative Period; Shoes; Treatment Failure
PubMed: 9575995
DOI: No ID Found -
HSS Journal : the Musculoskeletal... Feb 2007To describe the procedure of ultrasound-guided Morton's neuroma and recurrent stump neuroma injections and early clinical outcomes after a single injection.
PURPOSE
To describe the procedure of ultrasound-guided Morton's neuroma and recurrent stump neuroma injections and early clinical outcomes after a single injection.
MATERIALS AND METHODS
Retrospective review of 44 percutaneous ultrasound-guided neuroma injections in 24 patients who had completed clinical outcomes questionnaires. A 10-point pain scale [scale of 1 (no pain) to 10 (severe pain)] in a 7-day pain log format was distributed to patients at the time percutaneous neuroma injection was performed.
RESULTS
Neuromas were clearly visualized with sonography as hypoechoic nodules and were distinguishable from other causes of forefoot pain, such as metatarsophalangeal joint synovitis and intermetatarsal bursae. The sizes of the neuromas injected ranged between 4 and 19 mm. Postinjection, all neuromas displayed increased echogenicity and/or the appearance of fluid surrounding it, confirming localization of the therapeutic mixture. We arbitrarily subdivided the pain ratings into symptomatic (greater than 4) and asymptomatic (less than or equal to 4) for statistical analysis. Average pain level pre injection was 5.2 and average pain level was 3.7 at 7 days post single injection, with 62% of the initially symptomatic patients asymptomatic on day 7 (p < 0.000001). Overall, 76% of the total number of neuromas injected once were asymptomatic on day 7.
CONCLUSION
Ultrasound can be used to accurately target Morton's neuromas and, therefore, appropriately direct therapeutic interventions, with good short-term clinical results.
PubMed: 18751769
DOI: 10.1007/s11420-006-9029-9 -
Journal of Foot and Ankle Research 2016The main purpose of this study was to investigate the presence of an association between intermetatarsal neuroma and foot type, as measured by the Foot Posture Index....
BACKGROUND
The main purpose of this study was to investigate the presence of an association between intermetatarsal neuroma and foot type, as measured by the Foot Posture Index. The study also examined whether there was a relationship between foot type and the interspace affected with intermetatarsal neuroma, and whether ankle equinus or body mass index had an effect.
METHODS
In total, 100 participants were recruited from The University of Western Australia's Podiatry Clinic, 68 of whom were diagnosed with inter-metatarsal neuroma from 2009 to 2015. There were 32 control participants recruited from 2014 to 2015. The age of subjects was recorded, as were weight and height, which were used to calculate body mass index. The foot posture index and ankle dorsiflexion were measured using standard technique. Independent t-tests and Kruskal-Wallis tests were used to compare differences in foot posture index, body mass index and ankle dorsiflexion between the inter-metatarsal neuroma and control groups. Multivariable logistic regression was also used to model relationships for outcome.
RESULTS
The 68 intermetatarsal neuroma subjects had a mean age of 52 years (range 20 to 74 years) and comprised of 56 females and 12 males. The 32 control subjects had a mean age of 49 years (range 24 to 67 years) with 26 females and six males. There were no significant differences between the control and the intermetatarsal neuroma groups with respect to the mean foot posture index scores of the left and right foot ( 0.21 and 0.87, respectively). Additionally no significant differences were detected between the affected intermetatarsal neuroma interspace and foot posture index ( = 0.27 and 0.47, respectively). There was no significant difference in mean body mass index between the intermetatarsal neuroma (26.9 ± 5.7) and control groups (26.5 ± 4.1) ( = 0.72). There was, however, a significant difference in mean ankle dorsiflexion between the intermetatarsal neuroma and control groups ( < 0.001 for both feet). Logistic regression models, adjusted for age, sex, foot posture index and body mass index estimated that the odds of having an intermetatarsal neuroma in the right foot increased by 61% (OR 1.61; 95% CI 1.32-1.96) with each one degree reduction of ankle dorsiflexion, and in the left foot by 43% (OR 1.43; 95% CI 1.22-1.69).
CONCLUSION
No relationships were found between foot posture index and body mass index with intermetatarsal neuroma, or between foot posture index and the interspaces affected. However, a strong association was demonstrated between the presence of intermetatarsal neuroma and a restriction of ankle dorsiflexion.
Topics: Adult; Aged; Ankle Joint; Anthropometry; Body Mass Index; Case-Control Studies; Equinus Deformity; Female; Foot; Humans; Male; Middle Aged; Morton Neuroma; Posture; Range of Motion, Articular; Young Adult
PubMed: 27980684
DOI: 10.1186/s13047-016-0179-9 -
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 -
International Journal of Therapeutic... 2012Morton's neuroma is a common cause of pain that radiates from between the third and fourth metatarsals and which, when symptomatic, creates sensations of burning or...
BACKGROUND
Morton's neuroma is a common cause of pain that radiates from between the third and fourth metatarsals and which, when symptomatic, creates sensations of burning or sharp pain and numbness on the forefoot. Many conservative and surgical interventions are employed to reduce associated pain, but not enough research has been conducted to recommend patients to any one approach as the most reliable source of pain management.
PURPOSE
The objective of this case report is to describe the effect of massage therapy on one woman with symptomatic Morton's neuroma.
PARTICIPANT
A physically active 25-year-old female with diagnosed symptomatic Morton's neuroma who has not found relief with previous conservative intervention.
INTERVENTION
Six session of massage therapy once weekly for 60-75 minutes focused on postural alignment and localized foot and leg treatment. The client also completed an at-home exercise each day. Change was monitored each week by the massage therapist reassessing posture and by the client filling out a pain survey based on a Visual Analog Scale.
RESULTS
The client reported progressive change in the character of the pain from burning and stabbing before the first session to a dull, pulsing sensation after the third session. She also recorded a reduction in pain during exercise from a 5/10 to 0/10 (on a scale where 10 is extreme pain).
CONCLUSION
This study describes how massage therapy reduced pain from Morton's neuroma for one client; however, larger randomized control studies need to be done in order to determine the short- and long-term effects of massage therapy on this painful condition.
PubMed: 22811757
DOI: No ID Found