Manual therapy in the management of a patient with a symptomatic Morton's Neuroma: A case report

Sault, Josiah D.; Morris, Matthew V.; Jayaseelan, Dhinakar J.; Emerson, Alicia J.

doi:10.1016/j.math.2015.03.010

Cited by 8 publications

(10 citation statements)

References 29 publications

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“…4 Manual therapy and manipulations have been shown to improve symptoms in the treatment of MN in podia tric or chiropractic medicine when using clinical tests such as the digital nerve stretch test for diagnosis. 2,10,11 Waldecker found success with implementing mobiliza tion and manipulation in treating non-specific metatar salgia, but there was no suggestion of potential selftreatment options. 12 Govender and colleagues contended that a component of unresolved pain in MN was explained by untreated, mechanically induced metatarsalgia, which may be more amenable to exercise intervention.…”

Section: Discussionmentioning

confidence: 99%

“…12 Govender and colleagues contended that a component of unresolved pain in MN was explained by untreated, mechanically induced metatarsalgia, which may be more amenable to exercise intervention. 11 A pro posed theoretical framework (shown in Figure 3), modified from the current podiatrist clinical practice guidelines, 4 demonstrates the potential usefulness of physiotherapy in the examination, treatment, and triage process for those with MN.…”

Section: Discussionmentioning

confidence: 99%

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Mechanical Diagnosis and Therapy and Morton’s Neuroma: A Case Report

Post

2019

Physiotherapy Canada

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Purpose: Morton's neuroma (MN) is a neuralgia involving the common plantar digital nerves of the metatarsal region. Evidence-based treatment options for this condition are sparse, and physiotherapy's usefulness is limited. Client Description: A woman aged 44 years was referred to physiotherapy for left fore foot pain lasting 3 months. The podiatrist diagnosed MN using ultrasonography. Examination found positive squeeze test, painful interphalangeals and metatarsal heads, and painful metatarsophalangeal joint (MPJ) extension. Intervention: Repeated flexion of MPJ digit II relieved the patient's pain. She was treated six times over 3 months to progress treatment, achieve longer lasting pain relief, and recover function to full pain-free status, including running. Measures and Outcome: The patient's pain reduced after treatment from a variable 2-7 out of 10 on the Numeric Pain Rating Scale to 0 out of 10. After two sessions, the patient's Lower Extremity Functional Scale score improved, from 56 out of 80 to 70 out of 80, and by discharge, it was 73 out of 80. At 6-month follow-up, the patient was still running pain-free. Implications: This article describes the rapid and lasting improvement in chronic forefoot pain associated with MN after mechanical diagnosis and therapy assessment and treatment. Finding new, effective, conservative interventions is important for this condition because so few evidence-supported treatments exist. The findings from this case report demonstrate the benefit derived from exercise-based treatment and may indicate a role for physiotherapy in managing MN.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mechanical Diagnosis and Therapy and Morton’s Neuroma: A Case Report

Post

2019

Physiotherapy Canada

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“…Chiropractic and podiatric literature have reported success within this population in application of passive manual interventions, such as manipulation, to provide short-term relief of patient's symptomatic complaints [4,13]. A PT reported a single-case following a similar approach to describe short-term reductions in painpressure threshold testing [22]. Waldecker [23] displayed similar results over the short term when working with a more nonspecific population diagnosed with metatarsalgia symptomatology.…”

Section: Discussionmentioning

confidence: 99%

“…To date, there are limited cases in the literature which are suggestive of the utility of physical therapy in the presence of medically diagnosed Morton's neuroma. The overall prevalence rates when classifying this condition utilizing the MDT classification system is unknown [14,22].…”

Section: Discussionmentioning

confidence: 99%

Mechanical diagnosis and therapy and Morton’s neuroma: a case-series

Post¹,

Maccio

2019

Journal of Manual & Manipulative Therapy

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Objectives: Morton's neuroma (MN) is a neuralgia involving the common plantar digital nerves of the metatarsal region. Evidence-based treatment options for MN are sparse, and utility of physical therapy (PT) is unknown. Mechanical Diagnosis and Therapy (MDT) is a classification system utilizing direction-specific treatment for orthopedic conditions based on mechanical and symptomatic response to repeated end range movements. The purpose of this case series is to describe the management of three patients with a medical diagnosis of MN using the MDT classification system. Methods: Three female patients aged 54-75 years with unilateral plantar forefoot pain for 6 weeks to 8 years were referred by a podiatrist following positive clinically accepted diagnostic criteria for MN including radiological imaging and provocation testing. Patients were evaluated and treated utilizing MDT assessment and treatment principles. The intervention consisted of repeated movements matched to the patient's directional preference at either the lumbar spine (1 patient) or distal extremity (2 patients). Results: Immediate and one-year outcomes were excellent, demonstrating rapid and lasting improvement. Following discharge, the patients have been asymptomatic or able to selfmanage without seeking additional medical intervention for this condition. Total visit frequency per patient averaged 2-3 visits total across 8-16 days. Discussion: Responses to repeated end range movements testing allowed for classification and prescription of exercise to rapidly improve symptoms and function in three patients referred to PT services with medically diagnosed MN. This series provides preliminary evidence that MDT may be effective in classifying and treating patients with MN.

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“…First-line management is nonoperative [1]. The most reliable treatments include lifestyle modifications, such as avoidance of tight fitting shoes, orthotics, local infiltrations of corticosteroids [18,[23][24][25], as well as mobilisation and manipulation techniques [26][27][28][29]. Surgical intervention, recommended after failure of conservative therapies, includes neurectomy, i.e., excision of the affected CDPN segment, and neurolysis.…”

Section: Introductionmentioning

confidence: 99%

Fascial Manipulation Technique in the Conservative Management of Morton’s Syndrome: A Pilot Study

Biz

Stecco

Fantoni

et al. 2021

IJERPH

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Background and Objective: Morton’s syndrome (MS) is a common cause of neuropathic chronic forefoot pain, characterised by the development of a swelling of the common digital plantar nerve, whose aetiology is not fully known. There is currently no gold standard of treatment; nonoperative management commonly involves manual therapies, orthoses therapy and infiltrative techniques, while surgery is indicated after failure of conservative measures. The present preliminary study prospectively evaluates patients affected by MS treated by Fascial Manipulation technique (FM), a noninvasive manual therapy, focused on the release of the deep fascia, reducing its stiffness. Materials and Methods: Patients with clinical and sonographic diagnosis of MS with at least a 4-month history of neuropathic symptoms underwent a cycle of three weekly FM sessions. Clinical follow-up, including VAS and AOFAS scores, was performed 21 days (T1) and 3 months (T2) after treatment. Results: Nine patients, among 28 recruited initially, completed the manual therapy sessions and relative follow-up points. This noninvasive pain treatment led to significant improvement of VAS (p = 0.0034) and AOFAS scores (p = 0.0240) at the first follow-up (T1). At 3-month follow-up (T2), both scores decreased slightly, remaining however superior to the pre-treatment values. Only VAS was still significant (p = 0.0184). Conclusions: Despite the small size of the case series, this pilot study is unique in supporting Fascial Manipulation in the nonoperative treatment of MS. Further studies are needed with a large cohort of gender balanced patients to confirm the encouraging results obtained.

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Manual therapy in the management of a patient with a symptomatic Morton's Neuroma: A case report

Cited by 8 publications

References 29 publications

Mechanical Diagnosis and Therapy and Morton’s Neuroma: A Case Report

Mechanical Diagnosis and Therapy and Morton’s Neuroma: A Case Report

Mechanical diagnosis and therapy and Morton’s neuroma: a case-series

Fascial Manipulation Technique in the Conservative Management of Morton’s Syndrome: A Pilot Study

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