299 results on '"Morton Neuroma"'
Search Results
2. Study of AxoGuard® Nerve Cap and Neurectomy for Treatment of Symptomatic Neuroma & Prevention of Recurrent Neuroma Pain (REPOSE)
- Published
- 2024
3. A Characteristic Magnetic Resonance Imaging Finding to Identify Morton Neuroma: The Slug Sign.
- Author
-
Horita, Masahiro, Saiga, Kenta, Fujiwara, Tomohiro, Nakata, Eiji, and Ozaki, Toshifumi
- Subjects
FOOT radiography ,FOOT surgery ,PEARSON correlation (Statistics) ,NEUROMAS ,DATA analysis ,RESEARCH funding ,FOOT ,MAGNETIC resonance imaging ,RETROSPECTIVE studies ,DESCRIPTIVE statistics ,MEDICAL records ,ACQUISITION of data ,STATISTICS ,CASE studies ,SENSITIVITY & specificity (Statistics) ,TOES ,INNERVATION ,SYMPTOMS - Abstract
Background: Morton neuroma is a common cause of forefoot pain and sensory disturbances, but it is difficult to identify on magnetic resonance imaging (MRI). The aim of this study was to verify the usefulness of a characteristic MRI finding (slug sign) for identifying Morton neuroma and to clarify the relationship between excised neuroma characteristics and preoperative MRI findings. Methods: Twenty-two web spaces were retrospectively assessed from the second and third intermetatarsal spaces of 11 feet of 10 patients (7 women and 3 men, aged average 59.5 years) who underwent surgical excision of Morton neuroma between 2017 and 2022. Asymptomatic web spaces were used as control. Neuromas with 2 branches of the plantar digital nerves on axial T1-weighted MRI (MRI-T1WI) were considered the slug sign. We investigated the preoperative presence of the slug sign in Morton neuroma and asymptomatic control web spaces. We also investigated the relationship between the maximum transverse diameter of the excised specimen and that estimated on coronal MRI-T1WI. Results: A total of 15 Morton neuromas were excised and assessed. The slug signs were present in 10 intermetatarsal spaces in 15 web spaces with Morton neuroma whereas the sign was found in 1 intermetatarsal space in 7 asymptomatic web spaces. The sensitivity and specificity for the slug sign to diagnose Morton neuroma was 66.7% and 85.7%, respectively. The positive and negative predictive values were 90.9% and 54.5%, respectively. The mean maximum transverse diameter of excised neuromas was 4.7 mm. The mean maximum transverse diameter of neuromas on coronal MRI-T1WI was 3.4 mm. A significant positive correlation was found between the maximum transverse diameters of excised specimens and diameters estimated on coronal MRI-T1WI (r = 0.799, P <.001). Conclusion: The slug sign may be a useful indicator of Morton neuroma on MRI to confirm nerve involvement after bifurcation. Level of Evidence: Level IV, retrospective series. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
4. Safety and Efficacy of Percutaneous Morton Neuroma Cryoneurolysis Under Ultrasound Guidance.
- Author
-
Moulin, Benjamin, Angelopoulos, Giorgio, Sarrazin, Jean Luc, Romano, Stephane, Vignaux, Olivier, Guenoun, Thierry, Di Primio, Massimiliano, and Hakime, Antoine
- Subjects
TREATMENT effectiveness ,NEUROMAS ,ULTRASONIC imaging ,ANALGESIA ,CONSERVATIVE treatment ,BONE fractures - Abstract
Purpose: To assess the technical success, safety and early efficacy of Morton neuroma (MN) cryoneurolysis. Materials and Methods: Retrospective review of 54 consecutive patients with MN treated with cryoneurolysis after failure of conservative treatment, from September 2022 to June 2023. Outcomes measurements included technical success (defined a successful ultrasound-guided placement of the cryoprobe), procedural safety according to Cirse classification and change in 6 months post-procedure by pain numeric rating scale (pNRS). Results: A total of 59 MN were treated during 55 procedures. Mean procedure duration was 47 min, all patients were discharged 2 h after the intervention. Technical success was 98.1%. No Cirse grade 3, 4 or 5 complication was reported. Three grade 2 complication occurred, including two chilblain-type lesions and one bone insufficiency fracture. At 6 months post-procedure, pNRS score was significantly decreased (2.7 ± 2.2 vs 7.1 ± 1.1) (p < 0.0001), with a mean score decrease of 4.1points. Thirty-two patients (60.4%) reported a complete pain relief, 15 (28.3%) a partial pain relief and 6 (11.3%) no pain relief, or increased pain. Conclusion: Cryoneurolysis seems to be safe for the treatment of Morton neuroma. Six-month pain relief is promising and needs to be confirmed at long term. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
5. Radiofrequency Before to Surgical Removal of a Recalcitrant Morton´s Neuroma (REQUIEM)
- Author
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Alfonso Martínez Nova, Doctor
- Published
- 2023
6. Instrumental and clinical diagnosis of interdigital Morton neuroma
- Author
-
Daria A. Bolshakova, Andrey A. Kardanov, Musa N. Maysigov, Alexander А. Akhpashev, Dmitriy O. Ilyin, and Andrey V. Korolev
- Subjects
morton neuroma ,metatarsalgia ,magnetic resonance imaging ,mri ,Medicine - Abstract
Background: Interdigital neuroma is one of the most common diseases in foot surgery. It is a common cause of metatarsalgia leading to debilitating pain. At the same time, the diagnosis of neuroma can be a difficult task for an orthopedic surgeon due to the complex anatomy of the forefoot and a large number of soft-tissue and bone structures. Besides, the existing manual testing methods are not pathognomonic specifically for neuroma. The clinical symptoms and history, as well as a physical exam and instrumental evidence are important in assessing and grading the disease. However, there are no recommendations in the modern Russian literature regarding the need for routine visualization of neuroma. The reproducibility of the study, the absence of ionizing radiation and the possibility of obtaining a second opinion, as well as high sensitivity makes magnetic resonance imaging an important diagnostic tool in the diagnosis of neuroma. Aim: To evaluate the importance of the anamnesis and complaints and the sensitivity of clinical tests and magnetic resonance imaging of the foot in the diagnosis of interdigital neuromas. Methods: The study presents a retrospective analysis of the medical histories and outpatient records of 28 patients (8 men and 20 women) treated at the EMC ECSTO in the period from 2017 to 2022. The examination was performed according to a standardized protocol: collection of complaints and anamnesis, palpation, manual testing, including Mulder's click test. As a part of examination, magnetic resonance imaging of the foot was performed for all the patients. The average patient’s age at the time of the surgical treatment was 45 years. The resection of a part of the affected nerve with the subsequent histological examination was considered a gold standard for the treatment and verification of interdigital neuromas. In all the cases, the histopathological study confirmed the diagnosis. Results: The sensitivity of magnetic resonance imaging in the diagnosis of interdigital neuromas was 86%, the sensitivity of the Mulder test was 61%. Pain during the palpation of the affected interdigital space was determined in 100% of cases. Conclusion: The combination of a manual examination and magnetic resonance imaging, along with the analysis of complaints and anamnesis makes it possible to diagnose Morton's neuroma in most cases.
- Published
- 2024
- Full Text
- View/download PDF
7. Morton's Neuroma: Manipulation Versus Steroid Injection
- Author
-
Queen Margaret University
- Published
- 2023
8. US and MRI of the Forefoot: Intermetatarsal Bursitis or Morton's Neuroma
- Author
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The Danish Rheumatism Association, Hvidovre University Hospital, Bispebjerg Hospital, Gentofte Hospital, and Sif Binder Larsen, Principal Investigator
- Published
- 2023
9. Cryoanalgesia for the Treatment of Pain in Subjects With Morton's Neuroma
- Author
-
Pacira Pharmaceuticals, Inc and NorthBay Healthcare
- Published
- 2022
10. Comparative Effectiveness of Cryoablation Versus Steroid and Lidocaine Alone for Treatment of Morton's Neuroma
- Published
- 2022
11. Investigation of the Effect of Custom Made Insoles on Foot Pressure Distribution and Gait Parameters in Patients With Morton's Neuroma
- Author
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Özlem Feyzioğlu, Asistant Professor
- Published
- 2022
12. Are MR imaging and pathologic tissue sizes compatible in morton neuroma?
- Author
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Yasin Guler, Omer Serdar Hakyemez, Mehmet Seker, Asli Cakir, Adnan Kara, and Semih Ayanoglu
- Subjects
morton neuroma ,radiological dimension ,pathology ,mri ,Medicine - Abstract
It is claimed that Morton Neuroma (MN) is symptomatic if it is greater than 5mm. In contrast, significant amounts of Morton neuroma that do not reach this critical level may become symptomatic. Therefore, it is thought that MN size and intensity of symptoms do not show a positive correlation. Twenty patients who were operated at Medipol University School of Medicine between 2015-2019 for the diagnosis of Morton neuroma and whose disease was diagnosed as Morton Neuroma by MRI and pathological evaluation and were evaluated retrospectively. Pathological tissue size measurements and MRI measurements were compared. The mean age of the operated patients was 47, 14 were female and 6 were male. The average of the pathological tissue dimensions after the measurements was 16,6 mm. The average of the radiological image dimensions after the measurements was 8,5 mm. The pathologic dimension was significantly higher (p [Med-Science 2023; 12(2.000): 475-8]
- Published
- 2023
- Full Text
- View/download PDF
13. Comparison of the Effects of Morton's Neuroma on Foot Pressure Distribution and Gait Parameters in Pes Planus and Pes Cavus Patients
- Author
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Özlem Feyzioğlu, Assistant Professor
- Published
- 2021
14. Are MR imaging and pathologic tissue sizes compatible in morton neuroma?
- Author
-
Guler, Yasin, Hakyemez, Omer Serdar, Seker, Mehmet, Cakir, Asli, Kara, Adnan, and Ayanoglu, Semih
- Subjects
NEUROMAS ,MAGNETIC resonance imaging ,TISSUE physiology ,CLINICAL trials ,PATHOLOGY - Abstract
It is claimed that Morton Neuroma (MN) is symptomatic if it is greater than 5mm. In contrast, significant amounts of Morton neuroma that do not reach this critical level may become symptomatic. Therefore, it is thought that MN size and intensity of symptoms do not show a positive correlation. Twenty patients who were operated at Medipol University School of Medicine between 2015-2019 for the diagnosis of Morton neuroma and whose disease was diagnosed as Morton Neuroma by MRI and pathological evaluation and were evaluated retrospectively. Pathological tissue size measurements and MRI measurements were compared. The mean age of the operated patients was 47, 14 were female and 6 were male. The average of the pathological tissue dimensions after the measurements was 16,6 mm. The average of the radiological image dimensions after the measurements was 8,5 mm. The pathologic dimension was significantly higher (p<0.05) than the radiological dimension. After comparative measurements of MR images and pathological dimensions of Morton Neuroma, it was determined that there was a difference between them. Therefore, the surgical treatment option should not be determined according to the severity of clinical symptoms rather than size. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
15. Is Ultrasonography Comparable to MRI for the Detection of Morton Neuroma of the Foot?
- Published
- 2021
16. Feasibility of Specific Anesthesia of the Forefoot Preserving the Sensitivity of the Heel for Foot Surgery (DISTIB)
- Published
- 2020
17. Long-term comparison between blind and ultrasound-guided corticoid injections in Morton neuroma.
- Author
-
Santiago, Fernando Ruiz, Muñoz, Pablo Tomás, Ramos-Bossini, Antonio Jesús Láinez, Martínez, Alberto Martínez, and Olleta, Nicolás Prados
- Subjects
- *
ADRENOCORTICAL hormones , *EVALUATION research , *NEUROMAS , *PIPERIDINE , *TREATMENT effectiveness , *ULTRASONIC imaging , *RANDOMIZED controlled trials , *PAIN , *RESEARCH , *RESEARCH methodology , *COMPARATIVE studies - Abstract
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. [ABSTRACT FROM AUTHOR]- Published
- 2022
- Full Text
- View/download PDF
18. A problem-based approach in musculoskeletal ultrasonography: central metatarsalgia
- Author
-
Hye Min Son, Jee Won Chai, Yong Hee Kim, Dong Hyun Kim, Hyo Jin Kim, Jiwoon Seo, and Sung Moon Lee
- Subjects
metatarsalgia ,morton neuroma ,plantar plate ,forefoot ,ultrasonography ,Medical technology ,R855-855.5 - Abstract
Ultrasonography (US) is a useful diagnostic method that can be easily applied to identify the cause of metatarsalgia. The superficial location of structures in the foot, dynamic capability of US, and the ability to perform direct real-time evaluations of the pain site are also strong advantages of US as a modality for examining the foot. Moreover, knowing the possible pain sources to investigate when a patient has a specific site of pain will enhance the diagnostic quality of US, and will help radiologists to perform US efficiently and effectively. The purpose of this article is to review the common etiologies of metatarsalgia including Morton’s neuroma, plantar plate injury, synovitis, tenosynovitis, bursitis, and metatarsal fractures, and to discuss their US features.
- Published
- 2022
- Full Text
- View/download PDF
19. Revision Intermetatarsal Neurectomy
- Author
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Richardson, David R., Taylor, Brandon A., Berkowitz, Mark J., editor, Clare, Michael P., editor, Fortin, Paul T., editor, Schon, Lew C., editor, and Sanders, Roy W., editor
- Published
- 2020
- Full Text
- View/download PDF
20. Compare Ultrasound Assisted Cold Therapy and Lidocaine Injection to Treat Morton's Neuroma
- Author
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David Spinner, Associate Professor
- Published
- 2018
21. A Study to Evaluate the Safety and Efficacy of CNTX-4975 in Subjects With Painful Intermetatarsal Neuroma (Morton's Neuroma)
- Published
- 2018
22. Insole on Morton's Neuroma
- Author
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Conselho Nacional de Desenvolvimento Científico e Tecnológico and Hilda Alcantara Veiga de Oliveira, PT, MsC
- Published
- 2018
23. Injection Techniques for Common Chronic Pain Conditions of the Foot: A Comprehensive Review
- Author
-
Ivan Urits, Daniel Smoots, Henry Franscioni, Anjana Patel, Nathan Fackler, Seth Wiley, Amnon A. Berger, Hisham Kassem, Richard D. Urman, Laxmaiah Manchikanti, Alaa Abd-Elsayed, Alan D. Kaye, and Omar Viswanath
- Subjects
Achilles tendinopathy ,Ankle arthritis ,Foot pain ,Gout ,Injection techniques ,Morton neuroma ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract Purpose of Review This is a comprehensive literature review of the available evidence and techniques of foot injections for chronic pain conditions. It briefly describes common foot chronic pain syndromes and then reviews available injection techniques for each of these syndromes, weighing the available evidence and comparing the available approaches. Recent Findings Foot and ankle pain affects 20% of the population over 50 and significantly impairs mobility and ability to participate in activities of daily living (ADLs), as well as increases fall risk. It is commonly treated with costly surgery, at times with questionable efficacy. Injection therapy is challenging when the etiology is anatomical or compressive. Morton’s neuroma is a budging of the interdigital nerve. Steroid, alcohol, and capsaicin injections provide some benefit, but it is short lived. Hyaluronic acid (HA) injection provided long-term relief and could prove to be a viable treatment option. Achilles tendinopathy (AT) is most likely secondary to repeat tendon stress—platelet-rich-plasma (PRP) and prolotherapy have been trialed for this condition, but more evidence is required to show efficacy. Similar injections were trials for plantar fasciitis and achieved only short-term relief; however, some evidence suggests that PRP injections reduce the frequency of required therapy. Tarsal tunnel syndrome, a compressive neuropathy carries a risk of permanent neural injury if left untreated. Injection therapy can provide a bridge to surgery; however, surgical decompression remains the definitive therapy. When the etiology is inflammatory, steroid injection is more likely to provide benefit. This has been shown in several studies for gout, as well as osteoarthritis of the foot and ankle and treatment-refractory rheumatoid arthritis. HA showed similar benefit, possibly due to anti-inflammatory effects. Stem cell injections may provide the additional benefit of structure restoration. Summary Chronic foot pain is common in the general population and has significant associated morbidity and disability. Traditionally treated with surgery, these are costly and only somewhat effective. Injections provide an effective alternative financially and some evidence exists that they are effective in pain alleviation. However, current evidence is limited and the benefit described from injection therapy has been short-lived in most cases. Further studies in larger populations are required to evaluate the long-term effects of these treatments.
- Published
- 2020
- Full Text
- View/download PDF
24. One versus two adjacent interdigital neuroma excision: a patient outcome study
- Author
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Kefilwe Boineelo Benjamin, Nikiforos Saragas, and Paulo Ferrão
- Subjects
Foot ,Morton neuroma ,Neuroma ,Patient satisfaction ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
Objective: We aimed to evaluate patient satisfaction after surgery for both single and two adjacent neuromas. Methods: We reviewed the data of patients treated operatively for interdigital neuromas between 2003 and 2016. We interviewed them and administered the Self-Reported Foot and Ankle Score questionnaire. Patient scores were then analyzed categorically, and variation between groups was assessed. Results: Sixty-two patients were available for review. Thirty-one patients had a single interdigital neuroma excised and 31 had two adjacente interdigital neuromas excised. Twenty-eight of the 31 (90%) patients with a single neuroma had good or excellent results while 23 (74.2%) of those with adjacent neuromas had similar outcomes. One patient with a single neuroma had a poor result while four patients with adjacent neuromas had poor results. The mean score was 41 (excellent) for patients with a single interdigital neuroma and 37 (good) for those with adjacent neuromas (p=0.473). The majority of patients in both groups would undergo surgery again. Conclusion: We found no statistically significant difference in outcomes of patients who undergo surgery for either single or two adjacent interdigital neuromas. General patient satisfaction is good and/or excellent post excision. Level of Evidence II; Prognostic Studies; Retrospective Study.
- Published
- 2021
- Full Text
- View/download PDF
25. Blind and Ultrasound Guided Injection in Morton Neuroma
- Author
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FERNANDO RUIZ SANTIAGO, PhD, section chief musculoskeletal radiology
- Published
- 2017
26. A Study to Evaluate the Efficacy and Safety of CNTX-4975 in Subjects With Painful Intermetatarsal Neuroma (Morton's Neuroma)
- Published
- 2016
27. Morton's Neuroma: Manipulation Versus Steroid Injection
- Author
-
David Cashley, Mr David Cashley
- Published
- 2016
28. Evaluating the features of interdigital neuroma using 3-Tesla magnetic resonance imaging
- Author
-
Örmeci, Tuğrul, Güler, Olcay, Malkoç, Melih, Kaya, Nurullah, İşyar, Mehmet, Çakır, Aslı, Şen, Selva, and Mahiroğulları, Mahir
- Subjects
3-Tesla MRI ,Morton Neuroma ,Foot Pain ,Interdigital Neuroma ,Anatomy ,Metatarsalgia - Abstract
Interdigital neuroma is an entrapment neuropathy of the interdigital nerve. Previously, studies on interdigital neuroma were done with 1 Tesla Magnetic Resonance Imaging and more often 1.5 Tesla Magnetic Resonance Imaging. We used 3 Tesla Magnetic Resonance Imaging in our study and we did not encounter as much as we know about the study with 3 Tesla Magnetic Resonance Imaging in the literature. Between 2013 and 2019, the 3 Tesla Magnetic Resonance Imaging results of 39 consecutive surgically-confirmed interdigital neuromas and patients’ files were retrospectively evaluated. The soft tissue surrounding the prominent interdigital nerve “target sign” were assessed. Spearman’s rho, Pearson’s correlation tests, and Mann-Whitney U-tests were used. Of the 39 cases (mean transverse dimension = 4.64 mm), 35 (89.7%) were hypointense on T1-weighted sequencing, 34 were intermediate (87.1%) on short tau inversion recovery sequencing, and 29 (74.3%) had slightly-moderately enhanced neuromas on post-contrast spectral presaturation with inversion recovery sequences. A statistically significant negative relationship was found between contrast enhancement and disease duration (p = 0.020). On short tau inversion recovery or spectral presaturation with inversion recovery series, the intralesional nerve view “target sign” was observed in 23 (58.98 %) of 39 neuromas. This is the first study in the literature with 3 Tesla Magnetic Resonance Imaging that shows the visual characteristics of interdigital neuroma and its possible contribution to the diagnosis of the disease.
- Published
- 2023
29. Schwannoma of the First Webspace.
- Author
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Alçada, Rita, Caetano, João, Barreiros, Margarida, and Côrte-Real, Nuno
- Subjects
- *
NEUROMAS , *FOOT pain , *DIAGNOSIS , *SURGICAL excision , *SURGICAL diagnosis , *PAIN management - Abstract
Case: A 65-year-old man presented with plantar foot pain associated with a mass in the first webspace. A Morton neuroma was considered the probable diagnosis. Despite nonoperative treatment the pain continued. Surgical excision was performed, and histology was interpreted as a schwannoma. Symptoms resolved after surgery. Conclusion: Schwannoma of the foot is a rare condition, and to the best of our knowledge, this is the first case reported in the first webspace. Definitive treatment and diagnosis is surgical excision. Surgeons should consider schwannomas in the differential diagnosis of plantar foot pain because this can be misdiagnosed as a Morton neuroma. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
30. Study to Evaluate the Safety and Tolerability of CNTX-4975 in Subjects With Painful Intermetatarsal Neuroma (Morton's Neuroma)
- Published
- 2015
31. Fore Foot Pain: Morton Neuroma Surgery—Tips for Surgeons.
- Author
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Karslioglu, Bulent, Uzun, Metin, and Tokat, Fatma
- Subjects
- *
OPERATIVE surgery , *METATARSALGIA , *DISEASE relapse , *SURGICAL site , *COLLECTION & preservation of biological specimens - Abstract
Morton's neuroma is a mechanical neuropathy of plantar interdigital nerve. It is one of the most common causes of forefoot pain. One of the most undesirable complications of Morton's neuroma surgery is recurrent neuroma. Excision level of Morton's neuroma is important to prevent recurrence. In this study, we aimed to figure out preferred excision levels of orthopedic surgeons by evaluating pathological samples. Pathological specimens of 192 patients were prepared and examined by the same pathologist. One hundred thirty-nine patients were women (72.3%) and 53 were men (27.6%). The most common interspace affected was the third at 171 (89%) patients, followed by the second at 21 (11%). Mean age was 45.8 years (between 23 and 73). Twenty-two of them were left foot and the other 170 were right foot. Recurrent neuromas, pathological sample more than one piece from one surgical site, were excluded from the study. Pathological specimens were prepared and examined by the same pathologist. Gross pathological appearance and histopathological findings were recorded. Mean sample length was 2.05 cm (between 0.8 and 6 cm). One hundred forty-five samples were smaller (75.5%) than 3 cm, and only 47 samples (24.5%) were bigger than 3 cm. Our database results showed that majority of surgeons excise the nerve shorter than it should be. One of the reasons for high recurrence rates in Morton neurinoma may be inadequate excision of the nerve. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
32. Interdigital Commissural Approach for Morton's Neuroma.
- Author
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Yañez Arauz, Juan Manuel
- Abstract
Background: Morton's neuroma is a frequent cause of metatarsalgia. Operative treatment is indicated if nonoperative management has failed. The objective of the present study was to describe a technique of Morton's neuroma excision by a minimally invasive commissural approach and evaluate the long-term outcome and complications. Methods: A retrospective study of 108 patients with Morton's neuroma treated surgically with a commissural approach between September 1990 and December 2010 was performed. The surgical technique is described. Clinical outcomes and complications were evaluated. The average follow-up was 121 months. Eleven patients were men and 97 women. The average age was 49.4 years; 56.8% neuromas were at the third space and 43.2% at the second space. Six patients presented 2 neuromas in the same foot, and 9 patients had bilateral neuroma. Results: The visual analog scale (VAS) average pain score was 5.4 points preoperatively and 0.2 points at the final follow-up. The author found a significant difference between the VAS scores preoperatively and postoperatively (P <.01). Excellent and good satisfaction outcomes were achieved in 93.6%. The postoperative complication incidence was 3%. Conclusion: The author believes a minimally invasive commissural approach has advantages over a dorsal or plantar incision. It is a simple and reproducible technique, with satisfactory outcomes, low complication rates, and a quick return to usual activities. Level of Evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
33. Injection Techniques for Common Chronic Pain Conditions of the Foot: A Comprehensive Review.
- Author
-
Urits, Ivan, Smoots, Daniel, Franscioni, Henry, Patel, Anjana, Fackler, Nathan, Wiley, Seth, Berger, Amnon A., Kassem, Hisham, Urman, Richard D., Manchikanti, Laxmaiah, Abd-Elsayed, Alaa, Kaye, Alan D., and Viswanath, Omar
- Subjects
- *
PLANTAR fasciitis , *FOOT pain , *CHRONIC pain , *CHRONIC diseases , *ACHILLES tendinitis , *TREATMENT effectiveness , *INJECTIONS - Abstract
Purpose of Review: This is a comprehensive literature review of the available evidence and techniques of foot injections for chronic pain conditions. It briefly describes common foot chronic pain syndromes and then reviews available injection techniques for each of these syndromes, weighing the available evidence and comparing the available approaches. Recent Findings: Foot and ankle pain affects 20% of the population over 50 and significantly impairs mobility and ability to participate in activities of daily living (ADLs), as well as increases fall risk. It is commonly treated with costly surgery, at times with questionable efficacy. Injection therapy is challenging when the etiology is anatomical or compressive. Morton's neuroma is a budging of the interdigital nerve. Steroid, alcohol, and capsaicin injections provide some benefit, but it is short lived. Hyaluronic acid (HA) injection provided long-term relief and could prove to be a viable treatment option. Achilles tendinopathy (AT) is most likely secondary to repeat tendon stress—platelet-rich-plasma (PRP) and prolotherapy have been trialed for this condition, but more evidence is required to show efficacy. Similar injections were trials for plantar fasciitis and achieved only short-term relief; however, some evidence suggests that PRP injections reduce the frequency of required therapy. Tarsal tunnel syndrome, a compressive neuropathy carries a risk of permanent neural injury if left untreated. Injection therapy can provide a bridge to surgery; however, surgical decompression remains the definitive therapy. When the etiology is inflammatory, steroid injection is more likely to provide benefit. This has been shown in several studies for gout, as well as osteoarthritis of the foot and ankle and treatment-refractory rheumatoid arthritis. HA showed similar benefit, possibly due to anti-inflammatory effects. Stem cell injections may provide the additional benefit of structure restoration. Summary: Chronic foot pain is common in the general population and has significant associated morbidity and disability. Traditionally treated with surgery, these are costly and only somewhat effective. Injections provide an effective alternative financially and some evidence exists that they are effective in pain alleviation. However, current evidence is limited and the benefit described from injection therapy has been short-lived in most cases. Further studies in larger populations are required to evaluate the long-term effects of these treatments. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
34. Long-term comparison between blind and ultrasound-guided corticoid injections in Morton neuroma
- Author
-
Fernando Ruiz Santiago, Pablo Tomás Muñoz, Antonio Jesús Láinez Ramos-Bossini, Alberto Martínez Martínez, and Nicolás Prados Olleta
- Subjects
Neuroma ,Treatment Outcome ,Morton Neuroma ,Adrenal Cortex Hormones ,Mepivacaine ,Humans ,Pain ,Radiology, Nuclear Medicine and imaging ,General Medicine ,Ultrasonography, Interventional - Abstract
This work compares the effectiveness of blind versus ultrasound (US)-guided injections for Morton neuroma (MN) up to 3 years of follow-up.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.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 (p0.05). Improvement in MFPDI was superior in group 2 from 45 days to 2 years of follow-up (p0.05). Satisfaction with the treatment was higher in group 2 (87%) versus group 1 (59.1%) at 3 years of follow-up.Ultrasound-guided injections lead to a greater percentage of long-term improvement than blind injections in MN.• 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.
- Published
- 2022
35. Operative treatment options for Morton’s neuroma other than neurectomy − a systematic review
- Author
-
Woi Hyun Hong, Jun Young Choi, Su Whi Chae, Jin Soo Suh, and Min Jin Kim
- Subjects
medicine.medical_specialty ,Metatarsal osteotomy ,Foot ,Morton Neuroma ,business.industry ,medicine.medical_treatment ,Neurectomy ,Nerve decompression ,Morton's neuroma ,Evidence-based medicine ,Neuroma ,medicine.disease ,Denervation ,Osteotomy ,Surgery ,Foot Diseases ,Systematic review ,medicine ,Humans ,Orthopedics and Sports Medicine ,business ,Neurolysis - Abstract
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
- Published
- 2022
36. A Study to Characterize the Phenotype in Patients With Morton's Neuroma and to Explore the Effect of Local Administration of Xylocaine (Lidocaine)
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- 2012
37. Intra‐ and Interobserver Reliability of Size Measurement of Morton Neuromas on Sonography.
- Author
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Park, Young Hwan, Choi, Won Seok, Choi, Gi Won, and Kim, Hak Jun
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NEUROMAS ,ULTRASONIC imaging ,INTRACLASS correlation ,INTER-observer reliability ,TRANSVAGINAL ultrasonography - Abstract
Objectives: Sonography is often used for analysis of Morton neuromas, but the measurement reliability is unknown. The aim of this study was to determine the intra‐ and interobserver reliability and precision of sonographic measurement of Morton neuromas. Methods: Three observers with different levels of sonography experience (observer A, expert; observer B, intermediate; observer C, beginner) performed repeated measurements of the size of Morton's neuroma in 20 patients. Intraclass correlation coefficient and limit of agreement were used to evaluate reliability and measurement precision. Results: The intraclass correlation coefficient for intraobserver reliability was 0.80, 0.71, and 0.43 (limit of agreement, 20%, 18%, and 47%) in observers A, B, and C, respectively. The intraclass correlation coefficient for interobserver reliability was 0.72, 0.38, and 0.38 (limit of agreement, 25%, 36%, and 35%) between observers A/B, A/C, and B/C, respectively. Conclusions: The intra‐ and interobserver reliability values for sonographic measurement of Morton neuroma size were dependent on observer experience. Experienced observers had higher reliability, while observers who were less familiar with sonography showed moderate to low reliability. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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38. Prediction of Clinical Prognosis according to Intermetatarsal Distance and Neuroma Size on Ultrasonography in Morton Neuroma: A Prospective Observational Study.
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Park, Young Hwan, Kim, Tae Jin, Kim, Hak Jun, and Choi, Gi Won
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NEUROMAS ,ULTRASONIC imaging ,PROGNOSIS ,PATIENTS ,ADRENOCORTICAL hormones - Abstract
Objectives: This study aims to evaluate the clinical importance of intermetatarsal distance, size of neuroma, and proportion of neuroma in the intermetatarsal space in examinations of Morton neuroma using ultrasonography. Methods: Clinical prognosis was observed prospectively after corticosteroid injections in 136 patients with Morton neuroma, and the results were compared with ultrasonographic parameters of intermetatarsal distance, size of neuroma, and proportion of neuroma in the intermetatarsal space. Results: Twenty‐one patients (15%) did not respond to corticosteroid injections and underwent surgical treatment for Morton neuroma. Logistic regression analysis and receiver operating characteristic curve analysis showed that the size of the neuroma was the sole predictor of failure of corticosteroid injections (P = .002). No other factors were significant for the prediction of clinical prognosis (P > .05). Conclusions: The size of the neuroma on ultrasonography is the sole predictor of corticosteroid injection failure, while intermetatarsal distance and proportion of neuroma in the intermetatarsal space are not significant when predicting clinical prognosis of Morton neuroma. [ABSTRACT FROM AUTHOR]
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- 2019
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39. Short term comparison between blind and ultrasound guided injection in morton neuroma.
- Author
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Ruiz Santiago, Fernando, Prados Olleta, Nicolás, Tomás Muñoz, Pablo, Guzmán Álvarez, Luis, and Martínez Martínez, Alberto
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- *
NEUROMAS , *TRIAMCINOLONE , *SKIN , *INJECTIONS - Abstract
Objective: The aim of this work is to compare the effectiveness of blind and ultrasound-guided injection for Morton's neuroma (MN) to determine which is more appropriate as the initial procedure in conservative treatment.Methods: This is an evaluator-blinded randomised trial. Of the 56 included patients, 27 were assigned to the blind group (A) and 29 to the ultrasound-guided group (B). Injection includes 1 ml of 2% mepivacaine and 40 mg of triamcinolone in each web space with MN. The included patients were assessed clinically by VAS score and the Manchester Foot Pain and Disability Score (MFPDS). The follow-up was performed at 15 days, 1 month, 45 days, 2 months, 3 months and 6 months after the initial injection.Results: No differences in age or clinical measurements were found at presentation between group A and group B. At the follow-up, the ultrasound-guided group showed greater symptomatic relief at several stages of the follow-up: 45 days (VAS 3.0 ± 0.5 versus 5.5 ± 0.5, p = 0.001; MFPDS: 32.2 ± 1.8 versus 38.8 ± 2.0, p = 0.018), 2 months (VAS: 3.1 ± 0.5 versus 5.6 ± 0.5, p = 0.002; MFPDS: 31.5 ± 1.9 versus 38.5 ± 2.1, p = 0.020) and 3 months (VAS: 3.1 ± 0.4 versus 5.2 ± 0.6, p = 0.010; MFPDS: 31.2 ± 1.9 versus 37.7 ± 2.4, p = 0.047).Conclusion: Injection of MN under ultrasound guidance provides a statistically significant improvement at some stages of the follow-up (45 days, 2 and 3 months), compared with blind injection.Key Points: • Ultrasound-guided steroid injections in Morton's neuroma provide short-term pain relief to over 60% of the patients. • Ultrasound-guided injections in Morton's neuroma lead to a higher percentage of short-term pain relief than blind injections. • Ultrasound-guided injections in Morton's neuroma lead to a lower percentage of skin side effects than blind injections. [ABSTRACT FROM AUTHOR]- Published
- 2019
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40. A problem-based approach in musculoskeletal ultrasonography: central metatarsalgia
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Dae Yong Kim, Jee Won Chai, Jiwoon Seo, Yong Hee Kim, Sung-Moon Lee, Hyo Jin Kim, and Hyemin Son
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Metatarsalgia ,medicine.medical_specialty ,business.industry ,Forefoot ,medicine.disease ,Morton Neuroma ,medicine.anatomical_structure ,Musculoskeletal ultrasonography ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Plantar plate ,Ultrasonography ,business - Abstract
Ultrasonography (US) is a useful diagnostic method that can be easily applied to identify the cause of metatarsalgia. The superficial location of structures in the foot, dynamic capability of US, and the ability to perform direct real-time evaluations of the pain site are also strong advantages of US as a modality for examining the foot. Moreover, knowing the possible pain sources to investigate when a patient has a specific site of pain will enhance the diagnostic quality of US, and will help radiologists to perform US efficiently and effectively. The purpose of this article is to review the common etiologies of metatarsalgia including Morton’s neuroma, plantar plate injury, synovitis, tenosynovitis, bursitis, and metatarsal fractures, and to discuss their US features.
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- 2022
41. Comparison of Alcohol and Steroid Injection for Treating Morton's Neuroma
- Published
- 2006
42. ALGRX 4975 in the Treatment of Patients With Morton's Neuroma
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- 2005
43. Ultrasound-Guided Injection Treatments Versus Surgical Neurectomy for Morton Neuroma: A Cost-Effectiveness Analysis
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Soterios Gyftopoulos, Adam Jacobs, Kathryn L. Williams, Andrew B. Ross, and Robert K. Bour
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medicine.medical_specialty ,Ethanol ,Morton Neuroma ,business.industry ,Cost-Benefit Analysis ,medicine.medical_treatment ,Neurectomy ,Treatment options ,Health Care Costs ,General Medicine ,Cost-effectiveness analysis ,Denervation ,Ultrasound guided ,Surgery ,Treatment Outcome ,Adrenal Cortex Hormones ,otorhinolaryngologic diseases ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,Ultrasonography, Interventional ,Foot (unit) - Abstract
Background: Morton neuroma is a common, painful disorder of the foot with multiple treatment options of varying cost and effectiveness. Objective: The aim of this study was to determine the most co...
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- 2022
44. Metatarsal sliding osteotomy is effective without altering plantar pressure in Morton's neuroma: Retrospective case series.
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Suh JW, Jang HS, Kim KB, Kim JH, Choi SJ, Kim KR, Chu IT, and Park HW
- Abstract
Background: Various operative methods for the treatment of Morton's neuroma have been discussed, and osteotomy of the metatarsal bone has been reported recently. However, there has been no report of pedobarographic changes after metatarsal osteotomy. Pedobarographic changes of other metatarsal area after the surgery may cause transfer metatarsalgia, and thorough analysis of the pedobarographic data should be performed peri-operatively. The purpose of this study is to investigate the post-operative pedobarographic changes of sliding osteotomy of the 3rd metatarsal bone for treating Morton's neuroma., Methods: Forty patients (45 feet) who underwent metatarsal sliding osteotomy of the 3rd metatarsal bone for treating Morton's neuroma from November 2013 to December 2021 were retrospectively reviewed. Proximal sliding osteotomy was performed at the proximal 3rd metatarsal bone through dorsal approach. Clinical outcomes were evaluated with American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal Interphalangeal Scale (AOFAS LMIS), Foot Function Index (FFI), and Visual Analogue Scale (VAS). Plain radiograph and pedobarogram were performed to evaluate the radiologic and pedobarographic outcomes., Results: AOFAS score was improved from 52.8 ± 9.0 (18-62) to 88.8 ± 9.8 (78-100) and FFI was improved from 61.8 ± 4.9 (50-70) to 32.2 ± 5.1 (23-42) on average. The 3rd metatarsal bone was shortened by 3.1 ± 0.8 mm and dorsally shifted by 1.5 ± 0.4 mm after the surgery. Plantar intermetatarsal distances between 2nd and 3rd and 3rd and 4th metatarsal heads were significantly increased post-operatively. Average forefoot pressure and maximum pressure of the 2nd to 4th metatarsal head were not significantly changed between pre-operatively and post-operatively., Conclusion: Proximal metatarsal sliding osteotomy of the 3rd metatarsal bone shows a satisfactory result in both clinical and pedobarographical evaluations. It could be an effective treatment of permanent indirect decompression of Morton's neuroma with avoiding recurred neuroma, adhesion of tissue, paresthesia, and transfer metatarsalgia., Competing Interests: Declaration of competing interest No potential conflict of interest relevant to this article was reported., (Copyright © 2023. Published by Elsevier B.V.)
- Published
- 2023
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45. Morton Neuroma
- Author
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O’Donnell, Seth W., Blankenhorn, Brad D., Eltorai, Adam E. M., editor, Eberson, Craig P., editor, and Daniels, Alan H., editor
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- 2018
- Full Text
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46. Plantar and dorsal approaches for excision of morton's neuroma: a comparison study
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Wenpeng Xu, Ning Zhang, Zhengxun Li, Yifan Wang, Xiucun Li, Yang Wang, Haipeng Si, and Yong Hu
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Adult ,Pain, Postoperative ,Rheumatology ,Morton Neuroma ,Quality of Life ,Humans ,Orthopedics and Sports Medicine ,Middle Aged ,Metatarsal Bones ,Retrospective Studies - Abstract
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.
- Published
- 2022
47. A Method for Entubulating Exposed Nerve Ends Following Neurectomy Using a Porcine Extracellular Matrix Nerve Cap
- Author
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Craig H. Thomajan
- Subjects
Neuroma ,Swine ,Morton Neuroma ,Humans ,Animals ,Pain ,Orthopedics and Sports Medicine ,Surgery ,Podiatry ,Denervation ,Extracellular Matrix - Abstract
Compression and irritation at the plantar aspect of the transverse intermetatarsal ligament may lead to a compressive neuropathy called Morton’s neuroma. There are many treatment options for Morton’s neuroma, with the most common surgical option being traction neurectomy. While there has been success in many surgical procedures, up to 35% of patients treated with traction neurectomy have recurrent pain and up to one-third of these patients have a recurrent stump neuroma. These neuromas are caused by abnormal axonal growth during regeneration, leading to an unorganized mass of fibrotic collagenous tissues, Schwann cells, and axons. More recent surgical treatments of neuromas have included nerve capping, which has been proposed to prevent painful neuroma formation by isolating the nerve end from external chemosignaling and reducing disorganized axonal outgrowth. An off-the-shelf, biocompatible porcine small intestine submucosa (pSIS) derived nerve cap with internal chambering has been investigated in a rodent study, which showed less pain sensitivity and less axonal swirling indicative of reduced likelihood of neuroma formation. Furthermore, a recent clinical study indicated that patients experienced a significant reduction in pain 3 months after Morton’s neuroma excision followed by repair using a nerve cap. This article describes the surgical technique of the aforementioned clinical study to mitigate neuroma formation, where a Morton’s neuroma is excised, and the remaining proximal nerve stump is inserted within a nerve cap and buried in the surrounding muscle. Level of Evidence: Level V: Expert opinion
- Published
- 2022
48. Treatment of Morton's neuroma with minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) and percutaneous release of the deep transverse metatarsal ligament (DTML): a case series with minimum two-year follow-up
- Author
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Gustavo Sato, Gabriel Ferraz Ferreira, Davy Sevilla, Carolinne Nascimento Oliveira, Thomas Lorchan Lewis, Mauro Cesar Mattos e Dinato, and Miguel Viana Pereira Filho
- Subjects
Ligaments ,Morton Neuroma ,Child, Preschool ,Humans ,Pain ,Orthopedics and Sports Medicine ,Surgery ,Child ,Metatarsal Bones ,Follow-Up Studies ,Osteotomy - Abstract
The optimal treatment of symptomatic Morton's neuroma remains unclear; conservative methods are sometimes ineffective and neurectomy has significant rates of patient dissatisfaction. The aim of this study was to evaluate the outcome of minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) and percutaneous release of the deep transverse metatarsal ligament (DTML) in patients with Morton's neuroma.Between January 2018 and November 2019, 27 patients (29 feet) diagnosed with Morton's neuroma after clinical and radiological evaluation underwent DMMO and percutaneous DTML release. The primary clinical outcomes were pain (VAS) and function (AOFAS score). Secondary outcomes included patient satisfaction, complications, and radiographic outcomes. Patients were followed up for a minimum of two years.The median age of the participants was 66 years (range 48-79) and the follow-up time was 28 months (24-47). There was a decrease of 5.7 points in the VAS for pain (p .001) and an increase of 19.9 in AOFAS (p .001) after the surgical procedure. There was one case of superficial infection and one patient required resection of the neuroma (neurectomy). The majority of patients (89.7%) were satisfied and considered the procedure outcome as excellent or good.Treatment of Morton's neuroma with minimally invasive distal metatarsal metaphyseal osteotomy and percutaneous release of the deep transverse metatarsal ligament showed significant improvement in pain and function with a low incidence of complications and a high rate of personal satisfaction.
- Published
- 2022
49. An Updated Nerve Sparing Surgical Technique for Addressing Morton’s Neuroma
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Narendra Rajnikant Patel, Stephanie Oexeman, and Edgardo Rodriguez Collazo
- Subjects
medicine.medical_specialty ,Nerve sparing ,Foot ,Morton Neuroma ,business.industry ,Pain ,Morton's neuroma ,medicine.disease ,Surgery ,Foot Diseases ,Neuroma ,Humans ,Medicine ,Orthopedics and Sports Medicine ,business - Abstract
Morton's neuroma is a common painful pathology that occurs in the plantar forefoot. Many treatment options exist and surgical management is used after conservative treatment options fail. While within the literature, there is a high success rate with primary neurectomy procedures, the risk of recurrence of symptoms or "stump neuromas" remains difficult to treat and can lead to debilitating pain. This article expands on a previously published article to discuss an update on a nerve sparing, microneurosurgical, procedure for the management of Morton's neuromas.
- Published
- 2021
50. Extracorporeal Shockwave Therapy for Foot and Ankle Disorders: A Systematic Review and Meta-Analysis
- Author
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Tengku, Nazim B Tengku Yusof, Dexter, Seow, and Khushdeep S, Vig
- Subjects
Extracorporeal Shockwave Therapy ,Treatment Outcome ,Fasciitis, Plantar ,Morton Neuroma ,Tendinopathy ,Humans ,Heel Spur ,General Medicine ,Ankle ,Achilles Tendon - Abstract
Background: Extracorporeal shockwave therapy (ESWT) was first introduced into clinical practice in 1982 and has been a beneficial inclusion to the noninvasive treatment option of numerous orthopaedic pathologies. However, clinical evidence of the use of ESWT for various foot and ankle disorders has been limited with a consensus on its efficacy yet available. Therefore, the purpose of this study is to systematically review the literature, to provide a critical evaluation and meta-analysis for the use of ESWT in foot and ankle disorders. Methods: The PubMed and Embase databases were systematically reviewed and clinical studies that reported ESWT use for various foot and ankle disorders included. Results: A total of 24 clinical studies that included 12 randomized controlled trials and 12 case series were identified. Analysis of the evidence has indicated that ESWT can help manage plantar fasciitis, calcaneal spur, Achilles tendinopathy and Morton’s neuroma. Meta-analysis of the change in pre- to post-VAS overall scores for plantar fasciitis significantly favored ESWT compared to placebo/conservative treatment with a MD -3.10 (95% CI, -4.36 to -1.83; I2 = 68%; P < 0.00001). Conclusions: The current evidence has suggested that ESWT can provide symptomatic benefit to plantar fasciitis treatment, with minimal and unremarkable side effects. Overall, ESWT has been demonstrated to be a safe treatment option with a favorable complication profile. Further well-designed studies of ESWT for the treatment of calcaneal spurs, Achilles tendinopathy and Morton’s neuroma are warranted to more soundly and safely support its current use. Future studies are suggested to investigate the optimization of ESWT treatment protocols.
- Published
- 2022
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